MODERATE SEDATION STUDY GUIDE 2026 QUESTIONS
AND ANSWERS RATED A+
✔✔Discharge Criteria - ✔✔-Alert and Oriented to person, place, time
-Stable VS
-Stable SaO2 without supplemental O2 for at least 30 minutes after last narcotic,
sedation, or hypnotic medication
-Pain well controlled and easily managed with PO medications
-No protracted N/V
-Written/verbal release instructions given to patient
-Pt released in company of a responsible adult
-Provide 24h emergency contact phone number
-Return inpatients to room when considered stable and acceptable for routine ward
monitoring
-Documentation of release criteria on flow sheet
✔✔Aldrete Discharge Criteria Score - ✔✔-Total score greater than or equal to 8
-May not score a "0" in any category
✔✔Age-Specific Considerations: Geriatric - ✔✔*65 years*
-Functional age more important than chronological
-Careful titration and reduced doses of medications are required to avoid the
development of deep sedation states, prolonged recovery, and cardiovascular
depression
✔✔Geriatric Cardiovascular Changes - ✔✔-Decreased tissue elasticity = elevated BP
-Increased systolic BP due to ventricular hypertrophy and decreased arterial wall
compliance
-Cardiac output decreases by 1% for each year after 30
-Degenerative changes of the cardiac conduction system increase incidence of cardiac
dysrhythmias
-Decreased baroreceptor activity (sense BP activity)
✔✔Geriatric Pulmonary System Changes - ✔✔-Decreased total lung capacity (the most
air that you can inspire into your lungs)
-Decreased vital capacity (is the maximum amount of air a person can expel from the
lungs after a maximum inhalation)
-Decreased PaO2 (oxygen in arterial blood...75 to 100 mmHg)
-Altered ventilation response to hypercapnia and hypoxia
-Increased residual volume (the amount of air that remains in a person's lungs after fully
exhaling...1200mL)
-Increased dead space (representing the space in alveoli occupied by air that does not
participate in oxygen-carbon dioxide exchange)
-Laryngeal and pharyngeal reflexes are diminished
, ✔✔Geriatric Renal System Changes - ✔✔-Decreased glomerular filtration rate
-Decreased creatinine clearance
-Decreased tubular function (excretion)
-Decreased renal clearance of drugs and metabolites
-Prone to dehydration and electrolyte imbalance
✔✔Geriatric Hepatic System Changes - ✔✔-Decreased hepatic blood flow secondary to
decreased cardiac output
-Decreased microsomal enzyme activity
-Decreased ability to metabolize drugs
✔✔Geriatric GI System Changes - ✔✔-Increased gastric emptying time increases
incidence of reflux
✔✔Geriatric CNS Changes - ✔✔-Decreased peripheral, motor, sensory, and autonomic
nerve fibers = decreased rate of signal processing within the brain stem and spinal cord
-Impaired transport of amino acids and neuropeptides = neurogenic atrophy
-Higher activation thresholds needed for special senses such as vision, hearing, touch,
smell, pain, and temp.
-Decreased cerebral blood flow
-Decreased cerebral oxygen uptake
-Decreased response to and recovery from stress
-Decreased functional reserve
-Increased sensitivity to CNS depressant drugs
✔✔Pediatric Patient per American Academy of Pediatrics - ✔✔-Through the age of 17
years
✔✔Earliest age IV conscious sedation may be performed - ✔✔-Patients older than 9
months of age who are assessed Class I or Class II using the Physical Status
Classification of the American Society of Anesthesiologists System
✔✔Causes of rapid respiratory and CV decompensation in the pediatric patient - ✔✔-
Deep sedation
-Respiratory obstruction
-Painful procedures
✔✔Respiratory System Pediatric Considerations - ✔✔-Neonates and infants have
several anatomic differences that make them vulnerable to airway obstruction
-Presence of small alveoli through early childhood result in decreased lung compliance
-Neonates have very limited oxygen reserves during apneic periods; hypoxia develops
quickly
-Patients that have anatomical factors that are associated with difficult airway
management should be referred to anesthesia
AND ANSWERS RATED A+
✔✔Discharge Criteria - ✔✔-Alert and Oriented to person, place, time
-Stable VS
-Stable SaO2 without supplemental O2 for at least 30 minutes after last narcotic,
sedation, or hypnotic medication
-Pain well controlled and easily managed with PO medications
-No protracted N/V
-Written/verbal release instructions given to patient
-Pt released in company of a responsible adult
-Provide 24h emergency contact phone number
-Return inpatients to room when considered stable and acceptable for routine ward
monitoring
-Documentation of release criteria on flow sheet
✔✔Aldrete Discharge Criteria Score - ✔✔-Total score greater than or equal to 8
-May not score a "0" in any category
✔✔Age-Specific Considerations: Geriatric - ✔✔*65 years*
-Functional age more important than chronological
-Careful titration and reduced doses of medications are required to avoid the
development of deep sedation states, prolonged recovery, and cardiovascular
depression
✔✔Geriatric Cardiovascular Changes - ✔✔-Decreased tissue elasticity = elevated BP
-Increased systolic BP due to ventricular hypertrophy and decreased arterial wall
compliance
-Cardiac output decreases by 1% for each year after 30
-Degenerative changes of the cardiac conduction system increase incidence of cardiac
dysrhythmias
-Decreased baroreceptor activity (sense BP activity)
✔✔Geriatric Pulmonary System Changes - ✔✔-Decreased total lung capacity (the most
air that you can inspire into your lungs)
-Decreased vital capacity (is the maximum amount of air a person can expel from the
lungs after a maximum inhalation)
-Decreased PaO2 (oxygen in arterial blood...75 to 100 mmHg)
-Altered ventilation response to hypercapnia and hypoxia
-Increased residual volume (the amount of air that remains in a person's lungs after fully
exhaling...1200mL)
-Increased dead space (representing the space in alveoli occupied by air that does not
participate in oxygen-carbon dioxide exchange)
-Laryngeal and pharyngeal reflexes are diminished
, ✔✔Geriatric Renal System Changes - ✔✔-Decreased glomerular filtration rate
-Decreased creatinine clearance
-Decreased tubular function (excretion)
-Decreased renal clearance of drugs and metabolites
-Prone to dehydration and electrolyte imbalance
✔✔Geriatric Hepatic System Changes - ✔✔-Decreased hepatic blood flow secondary to
decreased cardiac output
-Decreased microsomal enzyme activity
-Decreased ability to metabolize drugs
✔✔Geriatric GI System Changes - ✔✔-Increased gastric emptying time increases
incidence of reflux
✔✔Geriatric CNS Changes - ✔✔-Decreased peripheral, motor, sensory, and autonomic
nerve fibers = decreased rate of signal processing within the brain stem and spinal cord
-Impaired transport of amino acids and neuropeptides = neurogenic atrophy
-Higher activation thresholds needed for special senses such as vision, hearing, touch,
smell, pain, and temp.
-Decreased cerebral blood flow
-Decreased cerebral oxygen uptake
-Decreased response to and recovery from stress
-Decreased functional reserve
-Increased sensitivity to CNS depressant drugs
✔✔Pediatric Patient per American Academy of Pediatrics - ✔✔-Through the age of 17
years
✔✔Earliest age IV conscious sedation may be performed - ✔✔-Patients older than 9
months of age who are assessed Class I or Class II using the Physical Status
Classification of the American Society of Anesthesiologists System
✔✔Causes of rapid respiratory and CV decompensation in the pediatric patient - ✔✔-
Deep sedation
-Respiratory obstruction
-Painful procedures
✔✔Respiratory System Pediatric Considerations - ✔✔-Neonates and infants have
several anatomic differences that make them vulnerable to airway obstruction
-Presence of small alveoli through early childhood result in decreased lung compliance
-Neonates have very limited oxygen reserves during apneic periods; hypoxia develops
quickly
-Patients that have anatomical factors that are associated with difficult airway
management should be referred to anesthesia
