Page 29 - HA Convention 2016 [Abstracts (Day 1)]

Masterclasses HOSPITAL AUTHORITY CONVENTION 2016

M3.1 Sedation Services in the Hospital Authority 13:15 Room 221

Overview of Sedation Service in Hospital Authority: Anaesthetic Perspectives
Chow YF
Department of Anaesthesia and Operation Theatre Services, Queen Elizabeth Hospital, Hong Kong

In addition to the growth of anaesthesia practice embracing the peri-operative period, anaesthesia has expanded to include
services to a wide variety of inpatient care. Providing anaesthetic services to patients outside the operating room is not a
new concept. Intensive care and pain management services have been well integrated in most HA hospitals. Sedation for
procedures in remote locations can optimise patient management in these situations and eliminate schedule waste in terms
of cancellations or postponements.

This presentation will share the concept of sedation anaesthesia continuum, the evolving scope of practice in different
diagnostic and interventional procedures for different patient groups, safety and efficacy, staff training, concerns and
challenges of achieving a safe and efficient sedation services by both anaesthetists and non-anaesthetists.

Tuesday, 3 May

M3.2 Sedation Services in the Hospital Authority 13:15 Room 221

Monitored Anaesthetic Care in Adult
Chan S
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong

Monitored Anaesthetic Care (MAC) is a specific anaesthetic service for diagnostic or therapeutic procedures performed under
local or regional anaesthesia along with sedation and analgesia, titrated to a level that preserves spontaneous breathing and
airway reflexes (Ref 1). MAC alone or with local anaesthetic accounts for a relatively high percentage of anaesthesia services
in developed countries and is the first choice in 10% to 30% of all surgical procedures (Ref 2).

The standard of care for MAC is essentially the same as general or regional anaesthesia, and includes a proper pre-
anaesthetic checkup, standard intraoperative monitoring and routine postoperative care. There is an obvious difference
between conscious (moderate) sedation and MAC, in which MAC includes support of vital functions and management of
possible intraoperative problems.

There is no single anaesthetic agent or technique that is superior to others. The choice of sedative or anaesthetic agents
varies and depends on: nature of procedure, physical condition of the patient, location of procedure and experience of the
anaesthesiologist.

Majority of diagnostic and therapeutic procedures in Hong Kong public hospitals are performed under conscious sedation
provided by the proceduralists and/or team member. With the introduction of sedation guideline by Hong Kong Academy of
Medicine in 2010, the standard and safety in relation to the sedation for these procedures has been made aware. There is an
increasing number of procedures in which anaesthesiologists have been requested for help in some major hospitals into a
regular OT list or on an ad hoc basis, especially for those high risk patients and/or certain high risk procedures. Due to limited
resource in the public sector, MAC service would have to be prioritised to the right patients and for the right procedures.

Reference
American Society of Anesthesiologists. Position on monitored anaesthesia care. 2008.
Ghisi D. Fanelli A, et al. Monitored anaesthesia care. Minerva Anesthesiology 2005;71:533-8.

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