In Reply

On behalf of the American Society of Anesthesiologists (ASA) Task Force on Moderate Procedural Sedation and Analgesia, we thank Dr. Cattano for his thoughtful Letter to the Editor regarding the ASA Practice Guidelines¹  published in March 2018. Dr. Cattano stated that the findings reported among four groups of specialists surveyed were incorrect regarding the recommendation “in urgent or emergent situations, where complete gastric emptying is not possible, do not delay moderate procedural sedation based on fasting time alone” and that he believed that the surveys showed all groups had a higher “nonagreement rate” regarding the practice. Our findings for all four groups, however, reported median scores that reflected “agreement” with the recommendation using a 5-point scale of “strong agreement” to “strong disagreement.” The data show that in all cases, a majority of respondents either strongly agreed or agreed with the recommendation, and the percentage of respondents who disagreed or strongly disagreed never exceeded 35%. If Dr. Cattano was referring to variability among the groups for the disagreement scores, differences in the percentages never exceeded 12.5% for any response category.

On page 447 of the Guidelines, the recommendation reads “Assure that practitioners administering sedative/analgesic medications intended for general anesthesia are able to reliably identify and rescue patients from unintended deep sedation or general anesthesia.” Dr. Cattano suggests that the reader may be confused by what may constitute a “practitioner.” It is the intent of all ASA’s clinical practice parameters to provide clinical guidance to individuals who already have the proper training. In this case, if a practitioner is administering moderate procedural sedation, the individual should already have had the proper education and training to rescue a patient from unintended deep sedation or general anesthesia. Educational background, credentialing, and other training qualifications should be left to local policy documents devoted to those issues.

Although the American College of Radiology and the Society of Interventional Radiology declined to participate in the member surveys, both organizations submitted names of individuals who participated in the expert consultant survey (table 7, pages 467 to 469). Both organizations assigned representatives to serve on the task force who were involved in the guidelines’ development from their conception through to the final product. Their representatives participated in creation of the evidence model, the literature search, consideration of survey results, drafting and editing of the recommendations, and much more.

Representatives from two other organizations as well participated in the development of the Guidelines—the American College of Cardiology and the American College of Emergency Physicians. Although these organizations ultimately declined to be included in the final publication, we thank them for appointing representatives who participated as task force members throughout our 2-yr process.