Conscious sedation versus monitored anaesthesia care.

1 regarding the safety of sedation practice done by untrained sedation practitioners. Non-anaesthesiologists are involved in sedation worldwide, and I agree that sedation of patients for minor procedures 'is here to stay'. But I am concerned that a dark picture is painted of conscious sedation, which is very safe when done by trained practitioners. In order to help solve the problem, we need to know who the authors are referring to when they state that 'Currently sedation is a poorly controlled practice, often performed in potentially unsafe environments by unqualified personnel who may be unable to deal with complications'. The authors claim that it is 'common practice with sedation [for] the sedative drugs [to be] given in large doses to attempt to achieve a calm, pain-free patient' – and refer to a 1972 article! There are many publications on conscious sedation and we all know and teach that titration is required to reach an optimal level of sedation and to avoid complications. The authors' comments on 'Where does this leave us in South Africa?' leave readers, not all of whom are anaesthesiologists, uninformed about what is being done in this country. The South African Dental Association published guidelines 2 on conscious sedation to address uncontrolled practice by 'unqualified practitioners'. The South African Society of Anaesthetists has also published guidelines. In a document on safe sedation the UK Academy of Medical Royal Colleges and their Faculties, chaired by the Royal College of Anaesthetists, stated, 'the key point is that safety will be optimized only if practitioners use defined methods of sedation for which they have received formal training'. The universities of Stellenbosch and the Western Cape have a university-accredited course on sedation and pain control/conscious sedation. It is presented by anaesthesiologists and attended by national and international students. We write a monthly article for the Journal of the Dental Association of South Africa covering all aspects of safe sedation practice. We also present a postgraduate university-accredited certificate course on sedation and pain management in association with University College London and are developing conscious sedation programmes. Our symposium in London in November 2006 was accredited for CPD by the Royal College of Anaesthetists. The authors state that the term 'conscious sedation' has been 'expanded, twisted and manipulated'. This is true – it is a worldwide phenomenon that practitioners do not always do what they are told. A recent survey showed that 70% …