Sedation is typically used in minor surgical procedures such as endoscopy, vasectomy, or dentistry and for reconstructive surgery, some cosmetic surgeries, removal of wisdom teeth, or for high-anxiety patients.[2] Sedation methods in dentistry include inhalation sedation (using nitrous oxide), oral sedation, and intravenous (IV) sedation. Inhalation sedation is also sometimes referred to as "relative analgesia".[citation needed]
There are studies claiming that sedation accounts for 40 percent to 50 percent procedure-related complications.[3]Airway obstruction, apnea, and hypotension are not uncommon during sedation and require the presence of health professionals who are suitably trained to detect and manage these problems. Aside from the respiratory depression, risks also include unintended levels of sedation, postoperative somnolence, aspiration,[4] and adverse reactions to sedation medications.[5] Complications could also include perforation, bleeding, and the stimulation of vasovagal reflexes.[6] To avoid sedation risks, care providers conduct a thorough pre-sedation evaluation and this process includes pre-sedation history and physicals with emphasis on the determining characteristics that indicate potential risks to the patient and potential difficult airway management.[7] This process can also reveal if the sedation period needs to be prolonged or additional therapeutic procedures are required.[8]
Levels of sedation
Levels of Sedation Under Anesthesia
Minimal Sedation: Also known as anxiolysis, minimal sedation involves a drug-induced state during which patients respond normally to verbal commands. Their cognitive function and physical coordination remain unaffected, and there is no compromise in airway reflexes or protective reflexes. This level of sedation is commonly used for procedures requiring minimal discomfort or anxiety relief, such as minor dental procedures or diagnostic tests.[9]
Moderate Sedation/Conscious Sedation: Moderate sedation, also referred to as conscious sedation, induces a drug-induced depression of consciousness, during which patients respond purposefully to verbal or light tactile stimulation. While maintaining spontaneous ventilation, patients may experience decreased anxiety and may have impaired cognitive function and physical coordination. However, they retain the ability to maintain their own airway and respond to commands. This level of sedation is commonly used for procedures such as endoscopic examinations, minor surgeries, or interventional radiology procedures.[9]
Deep Sedation: Deep sedation involves a drug-induced depression of consciousness, during which patients may not respond purposefully to verbal or tactile stimulation. Patients under deep sedation may require assistance in maintaining their airway, and spontaneous ventilation may be inadequate. However, patients still maintain cardiovascular function. This level of sedation is often used for procedures requiring significant analgesia and amnesia, such as major surgical procedures or certain diagnostic imaging studies.[9]
General Anesthesia: General anesthesia involves a drug-induced state during which patients are unarousable, even in the presence of painful stimulation. Patients under general anesthesia require assistance in maintaining their airway and ventilation, and cardiovascular function may be impaired. General anesthesia is characterized by a complete loss of consciousness and protective reflexes, allowing for surgical procedures to be performed without pain or awareness. This level of sedation is utilized for major surgical procedures or invasive diagnostic procedures where unconsciousness and muscle relaxation are necessary.[9]
These levels of sedation under anesthesia are defined by the American Society of Anesthesiologists (ASA) and are crucial in determining the appropriate level of sedation for each patient and procedure, ensuring patient safety and comfort throughout the perioperative period.[9]
Intravenous sedation
The most common standard conscious sedation technique for adults is intravenous sedation using Midazolam. This requires a needle to be put into a vein to deliver the medication; this is known as an IV cannula.[citation needed]
Whenever it is necessary to sedate a child, one must consider the type of procedure planned (painful or nonpainful), the duration of the procedure (important in choosing the appropriate sedative), the underlying medical condition of the patient (proper fasting, contracted blood volume, interaction with other medications, and intact mechanisms of drug elimination), the need for anxiolysisornarcosis, and experience with alternative techniques or routes of administration.
A child undergoing a procedure that is nonpainful (e.g., CT scan or small laceration infiltrated with local anesthetic) does not require a narcotic. Conversely, a child undergoing a painful procedure may require an opioid.[10]
^Vargo, John (2016). Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America. Philadelphia, PA: Elsevier Health Sciences. p. 465. ISBN9780323448451.
^Odom-Forren, Jan; Watson, Donna (2005). Practical Guide to Moderate Sedation/analgesia. St. Louis, MO: Elsevier Mosby. p. 84. ISBN0323020240.
^Vargo, John (2016). Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America. Philadelphia, PA: Elsevier Health Sciences. p. 554. ISBN9780323448451.
^Mason, Keira (2011). Pediatric Sedation Outside of the Operating Room: A Multispecialty International Collaboration. New York: Springer. p. 166. ISBN9780387097138.
^Winter, Harland; Murphy, Stephen; Mougenot, Jean Francois; Cadranel, Samy (2006). Pediatric Gastrointestinal Endoscopy: Textbook and Atlas. Hamilton, Ontario: BC Decker Inc. p. 59. ISBN1550092235.
