Sedation scales such as the Ramsay Scale7 or Richmond
Agitation Sedation Scale8 are used to assess purposeful,
goal-directed sedation during procedures or in ventilated,
critically ill patients, and are not recommended for use
during opioid administration for pain management
because they incorporate assessment of other conditions
in addition to sedation.2 Most goal-directed sedation scales
link anxiety or agitation to the sedation scale, which complicates
assessment because agitation and anxiety are not
indicators of increasing opioid-induced sedation. Patients
may be either calm or anxious and sedated. Further, the
scales used for assessment of purposeful, goal-directed
sedation were not developed for assessment of sedation
during opioid administration for pain management. Similarly,
simple sedation scales such as the POSS were not
developed for assessment of purposeful, goal-directed