A recent guideline from the American College of Emergency Physicians on unscheduled procedural sedation is interesting to compare with American Society of Anesthesiologists’ views on sedation. There have been longstanding tensions between the ASA and others who administer sedation such as gastroenterologists and dentists.
The ACEP take the view that the proceduralist can give or direct giving sedation and that the level of responsiveness and ventilation are more important than the agent used (clearing the way for Propofol!). Skills are needed to rescue a patient who slips into deep sedation or general anesthesia.
The risk of gastric aspiration so central to Anesthesia practice is downplayed with reasonable evidence of how rare an occurrence it is, an issue sure to provoke controversy.