Some medical procedures may be uncomfortable or painful. In these cases, general anesthesia might not always be necessary, while without medication it may be traumatizing for the patient. Therefore, clinicians developed “conscious sedation”, a procedure giving moderate sedation while the patient can still respond to verbal direction. It is also known as procedural sedation.
Patients, who receive conscious sedation usually, are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider. In some cases, patients are also given drugs which are supposed to help them forget the procedure. Medical procedures can be traumatizing, and these drugs are designed to reduce bad memories which could cause nightmares, panic attacks, and other unpleasant symptoms.
Although it might seem like a pleasent procedure to go through, it is not without risk. Patients are carefully reviewed before being selected as candidates for conscious sedation and the doctor also goes over the risks, advantages, and alternatives with the patient. During the period of conscious sedation, at least one medical personel monitors the patient at all times, looking at heart rate, breathing, and dissolved oxygen levels in the blood, so that adverse reactions can be quickly identified and addressed. While another personel performs the procedure.
The depth of sedation is very important. When the sedation is “too light” the patient will still feel discomfort and pain. When the sedation is “too deep” the patient might fall into a deep sleep even stop breathing. However, this apneic or no breathing state is usually reversible and breathing will be back to normal as the drug wears out.
Some side effects associated with conscious sedation, ie. the patient may feel nauseous, sometimes vomiting when they wake up, and headaches and a sense of being hung over are common. It is important to drink lots of fluids after conscious sedation, and to report lingering side effects to a doctor.
Although it can be performed by a general practitioner or emergency physician, sometimes an anesthesiologist may still be needed if the procedure likely cannot be done without deep sedation. It should also be considered if the patient has a number of medical problems. In that situation, anesthesia providers have more training and experience in how sedation interacts with other medications and how these medical problems might affect the sedation. Clearly, a patient that has had previous difficulty with sedation or anesthesia should probably seek the expertise an anesthesiologist can provide.
In the end the decision whether to have conscious sedation or to have a deeper level of sedation is a choice that must be tailored to each individual situation. What is needed depends on the procedure planned, the patient’s expectations and desires, the patient’s medical condition, etc. Just as there is not a single anesthetic that works for every surgery and every patient, there is not one method of sedation that works every time. As always, patients should be encouraged to ask questions, explore options and, together with their physician, make a choice that is both safe and effective.
Discuss your medical procedures with one of our BIMC doctor’s who can provide conscious sedation when necessary.