Sedation
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Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, propofol, etomidate, ketamine, pentobarbital, lorazepam and midazolam.[1]
Medical uses
Sedation is typically used in minor surgical procedures such as
Sedation is also used extensively in the
Risks
There are studies claiming that sedation accounts for 40 percent to 50 percent procedure-related complications.
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]
Indications:[citation needed]
- Reduced dental anxiety and phobia
- Traumatic or prolonged dental procedures
- Patients with gag reflex
- Medical conditions potentially aggravated by the stress of dental treatment
- Special care (mild intellectual or physical disability)
- Some disorders involving its spasticity due to its muscle relaxant properties
Contraindications:[citation needed]
- Uncooperative patient
- Psychologically immature individuals
- Patients unable to provide a suitable escort
- Difficult oral surgery or prolonged surgical procedure
- Muscle diseases or diseases which cause muscle wastage
- ASA III or above
- Allergy or hypersensitivity to benzodiazepines
- Pregnancy and breast feeding
- History of psychiatric disorders
- Kidney or liver dysfunction
- Acute pulmonary insufficiency
- Preexisting respiratory conditions as patients are susceptible to respiratory depression
- Alcohol or drug addiction
- Lack of visible superficial veins
Sedation for pediatric patients
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Present drugs commonly used to sedate children: Methohexital; Thiopental; Benzodiazepines; Diazepam; Midazolam; Ketamine; Opioids; Morphine; Meperidine; Fentanyl.
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
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]
See also
- Palliative sedation
- Procedural sedation
- Sedoanalgesia
- Twilight anesthesia
References
- PMID 15663030.
- ^ "Sedation Dentistry for Anxious Patients". Archived from the original on 2014-09-23. Retrieved 2014-09-11.
- ISBN 9780323448451.
- ISBN 0323020240.
- ISBN 9780323448451.
- ISBN 1861562667.
- ISBN 9780387097138.
- ISBN 1550092235.
- ^ a b c d e "Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia". www.asahq.org. Retrieved 2024-03-18.
- .