Feasibility of Using Richmond Agitation Sedation Scale in Procedural Sedation

Abstract

Aim/Objectives/ Background The aim of the study is to test the validity of Richmond Agitation Sedation Scale in the field of anesthesia. Sedation is to provide comfort to patients during unpleasant diagnostic or therapeutic procedures, monitored anesthesia care (MAC) is not limited to watching the level of sedation but for tailoring sedation to the need for the patient/procedure. Many scales have been designed to monitor the depth of anesthesia in the intensive care unit for those who are in need for sedation, from this scales Richmond Agitation Sedation Scale (RASS) was approved. Methods The study is a double blinded cross sectional observational study. The patients scheduled for upper GIT endoscopy were randomly divided into group R and group N, sedation was started to the targeted level. If the targeted level of sedation not achieved. Propofol at a dose of 0.5 mg/kg administrated over 3-5 min .titrated till the clinical response were achieved, In group R, the level of sedation was monitored using Richmond sedation agitation scale While in group N, the level of sedation was monitored based on the defined level of sedation according to the ASA. The time of the procedure, length of the hospital stay and the recovery time was recorded. In the postoperative visit, the patient’s satisfaction was assessed, based on a Questionnaire of 5 yes or no Questions.. The Feasibility was examined using, simplicity and ease of use, ease of recall, precise discriminating criteria for each level, sufficient levels for sedative medication titration, measurement of agitation. Results The difference in the procedure time between the two groups were not significant, the time recorded to reach the targeted sedation level were statistically significant where it was longer in group N 19.2±4.2 min vs 18.4±5.2 min., the difference in the recovery time between the two groups 5(3) vs 2(1) were not significant. the level of satisfaction was achieved at a low scale of sedation in group R, No delay in the discharge time among the two groups, the validity for the application of the scale were 16(35.5%) vs 6(13.3%). Inter rater correlation using Cohen’s Kappa yield a correlation of 0.9 denoting perfect correlation. Conclusion RASS is a valid and reliable tool for monitoring the level of sedation in procedural sedation especially if a limited modification applied on it.