Pearls

Three clinical tips that might further enhance safety in your procedural sedation practice:

• Use a decent size pillow pre-emptively to better achieve the “sniffing the morning air” position; your patients will consider you a saint regardless of whether it prevents airway compromise or not!
• Tilt the head end of the trolley upright if your obese patient is hypoventilating, or if you are required to provide bag mask ventilation. Is there any reason not to have them in this position from the outset?
• Consider a 500ml bolus of saline pre-procedure in elderly patients on hypertensive medication, with a further bolus primed in anticipation of a drop in blood pressure.