SEDATION SCALES AND MEASURES A LITERATURE REVIEW Tim Newton BA PhD CPSychol Ioana Pop BDS MSc EUaDuvallBScMSc King's College London Dental Institute Address correspondence to: JT Newton Social Gf Behavioural Sciences, King's College London Dental Institute Denmark Hill Campus, London SE5 9RW Tel: 02032993481 Fax: 02032993409 Email: tim.newton@kcl.ac.uk
Abstract
T
he monitoring and assessment of the degree of conscious sedation experienced by patients is important for both chnical practice and in research. Whereas chnical monitoring remains the gold standard for safety in patient care, numerous measures are avaUable to supplement this and to provide quantitative data on level of sedation. This manuscript provides an overview of existing measures of the degree of sedation. Scales that have been used in pubhshed research were identified from a search of MedUne and Google Scholar, and for each scale we identified the characteristics of the scale and degree to which the reliabiUty and vaUdity of the scale had been measured. A total of 35 different measures of degree of sedation were identified. Data on reUability and/or vaUdity were unavailable for many. The Ramsay Sedation Scale emerged as a brief measure v^dth good psychometric and which has been widely used. It is recommended as an adjunct to practitioner assessment in cUnical care. For research purposes the Sedation Agitation Scale for adult patients and the Observer's Assessment of Alertness/ Sedation Scale for adults or chUdren showed promise.
Introduction Administration of conscious sedation requires constant monitoring of the sedated patient. Accordingly, cUnicians
require tools that measure the effectiveness of sedation in individual patients in relation to the objectives of sedation. Instruments such as sedation scales or scoring systems should ideaUy be simple and user-friendly, yet should have also undergone rigorous development and appropriate testing to demonstrate vaUdity, reUabUity and responsiveness. Management of analgesia and sedation in dentistry and medicine requires evaluation and monitoring of key parameters such as operative conditions, patient comfort and satisfaction, in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management. The need for frequent measurement refiects the dynamic nature of pain, agitation, and sedation. Further, close rnonitoring helps to avoid over-sedation and to ehminate pain and agitation. Pain assessment tools include self-report (often using a numeric pain scale) for communicative patients and pain scales that incorporate observed behaviours and physiologic measures for noncommunicative patients. *" A key component of this approach is the use of a sedation scale or scoring systems, a tool that can enhance accurate and consistent medication titration by chnicians, improve understanding and communication, and reduce the incidence of excessive drug-induced complications.'^'