Sedation Explained
Conscious sedation is the safe and effective administration of drugs that relieve anxiety and reduce pain.
The aim of conscious sedation is to make the patient as comfortable as possible, whilst monitoring the patient continuosly, so that the procedure can be completed in a completely safe environment.
Certain procedures (medical and dental) can be performed safely and efficiently under conscious sedation outside of the theatre environment (it is in the dentist or medical practitioners rooms). Sedation presents a cost-effective alternative to general anaesthetic in selected patients and procedures, and can be done out of theatre settings.
The goal of sedation is to minimize anxiety and pain. The side effects experienced with conscious sedation are minimal compared with general anaesthetic. Very few patients experience any side effect at all. The incidence of post sedation nausea and vomiting is as low as 0.7%.
Costs of conscious sedation are significantly lower compared to the traditional theatre based general anaesthetic option.
The Continuum of sedation
Sedation, simply defined, is the production of a depressed state involving a lack of total consciousness with the help of pharmacological agents. In sedation, the protective pharyngeal and laryngeal reflexes are not dulled, so the patient can maintain his or her own airway. In this sedated state, the functional activity or the higher centres of the central nervous system is reduced without distortion of the vital functions.
The continuum of sedation is as follows:
• Minimum sedation or anxiolysis: Responds normally to verbal commands.
• Moderate sedation and analgesia or conscious sedation: Responds purposefully
to verbal commands or light touch.
• Deep sedation and analgesia: Responds purposefully to repeated or painful
stimuli.
• General anaesthesia: No response or reflex withdrawal.
It is generally agreed that for sedation to be conscious, it is imperative that:
• The patient should be able to maintain his/her own airway
• The patient remains haemodynamically stable
• The patient’s protective reflexes remain intact
• The patient is able to react to verbal stimulus or light touch.