Introduction
Conscious sedation is used in some surgical cases. It makes the patient sleepy while surgical procedures are done. It is safer than anesthesia. The patient is in twilight sleep when in conscious sedation. Therefore, it is an effective way of treating minor surgeries. This topic elaborates on conscious sedation, its usage in surgical procedures, and the difference between general anesthesia and sedation.
What Is Conscious Sedation?
A level of sedation in which a person is asleep but can communicate. Conscious sedation makes the patient sleepy. The patient can independently maintain their airway; no intubation is required. Conscious sedation helps the patient to reduce pain and anxiety during surgery. Certain medications or sedatives are required to make patients conscious while blocking the pain nerves during medical surgery or procedures. The patient's breathing rate and blood pressure can go low, so monitoring the patient during treatment is essential.
Where Is Conscious Sedation Performed?
Conscious sedative medicine is performed in hospitals or any outpatient centers or clinics. It is used in dental clinics also. Primarily minor surgeries can be performed under conscious sedation.
Who Can Administer Conscious Sedatives?
Conscious sedation does not require an anesthesiologist (a doctor who gives anesthesia) and can be provided by a nurse, doctor, or dentist. It can be given intravenously (injection into a vein) or intramuscularly (injected into the muscle). The providers who have injected sedatives are always present during the procedure. Although the patient does not require airway maintenance, monitoring is essential.
What Does the Patient Feel in Conscious Sedation?
Sedatives soon after injecting work on the nervous system and make the patient feel drowsy and relaxed. Further, a tingling sensation starts expressing in the body. The patient feels heaviness in their body and possibly cannot move their body. The body's reaction to the outer environment gets slow, and reflexes are delayed. Even the blood pressure gets low, and the breathing rate gets slow. Nearly it takes 15 to 30 minutes to work on the patient thoroughly.
How Is Conscious Sedation Administered?
There are different methods that can administer sedatives. Some of the commonly used methods are:
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Oral.
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Intravenously.
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Intramuscularly.
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Nasally.
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Rectal.
What Are the Drugs Used in Conscious Sedation?
The medication for conscious sedation requires a sedative along with an analgesic drug. Most doctors use a low dose of rapid and acting drugs. Commonly used drugs with their side effects are listed below:
1. Midazolam - It is a benzodiazepine drug that can be used in children too. It can work rapidly with low doses. It shows a complete amnesia (memory loss) effect. It has low pain while injecting.
- Side Effects - It does not have any pain-relieving effect. Sometimes cases have shown low blood pressure and respiratory depression.
2. Fentanyl - Fentanyl is a synthetic opioid that doctors can use on children and adults. It is also a rapid and short-acting drug. Unlike Midazolam, it has analgesic properties and fewer effects on the heart.
- Side Effects - It has shown respiratory depression and low blood pressure. It has expressed nausea and vomiting postoperatively.
3. Ketamine - It is a dissociative anesthetic that is used in all kinds of patients. It is a rapid and short-acting drug that lacks respiratory depression postoperatively, unlike Midazolam and Fentanyl.
- Side Effects - Patients may have delirium and hallucinations. The patient may face high blood pressure (hypertension) and a fast heart rate (tachycardia).
4. Propofol - It is a sedative drug that causes hypnosis. Its monitoring is essential after induction because it can cause deep sedation (unconsciousness). It is probably used to start the sedation effect. It does not cause any seizures.
- Side effects - It can show a burning sensation on the injection site. It can cause respiratory and cardiovascular depression along with low blood pressure.
5. Etomidate - It is a sedative drug with a short and rapid action. Etomidate has limited effects on the cardiovascular and respiratory systems.
- Side effects - It lacks any analgesic effects, thus causing pain on injection. Postoperative nausea and vomiting and sometimes seizures can be seen after Etomidate injection.
6. Dexmedetomidine - It is a hypnotic drug with light sedation effects. Safer for pediatric patients with a rapid onset and ultra-short duration of effect. It does not affect the respiratory system. The patient can verbally communicate under sedation.
- Side effects - It lacks analgesic effects. It lowers blood pressure and heart rate.
7. Methohexital - It is a barbiturate and safer for pediatric patients. It has a rapid onset and ultra-short-acting duration.
- Side effects - It can cause respiratory depression and seizures.
8. Nitrous oxide - Nitrous oxide is called laughing gas. It has sedative and analgesic properties. It shows short duration and quick recovery. It offers fewer respiratory and cardiovascular effects than others.
- Side effects - It causes nausea and vomiting with weak anesthetic effects.
How Is the Recovery in Conscious Sedation?
The recovery from conscious sedation is speedy. It is quicker than anesthesia. The patient needs to stay in the operating room for an hour or till they do not feel fully awake. However, drowsiness and lightheadedness can accompany the patient. Before leaving the operating room, the doctor should ensure the patient's blood pressure, breathing rate, temperature, and heart rate are normal. If the reversal of the conscious sedation is required earlier or soon after the procedure, two reversal drugs: Naloxone and Flumazenil, can be used.
What Are the Indications of Conscious Sedation?
Indications are:
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Breast biopsy.
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Dental procedures.
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Minor bone fracture repair.
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Minor skin surgery.
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Minor foot surgery.
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Procedures to diagnose like endoscopy (viewing the stomach by inserting a tube), colonoscopy (viewing the colon by inserting a tube with a camera), and bronchoscopy (viewing the inner part of the lung by inserting a flexible tube and a camera).
How Is Conscious Sedation Different From General Anesthesia?
General anesthesia is a complete state of unconsciousness where the patient's airway has to be maintained, and the recovery of the patient from unconsciousness to consciousness takes a lot of time. In comparison, conscious sedation is a state of sedation where the patient is partially awake and can even respond verbally to commands. However, the patient is unable to act over the activity around them. The patient himself maintains the airway of the patient. Therefore, recovery is much quicker than general anesthesia.
Conclusion
Conscious sedation is a state of sedation in which a patient is partially awake and can respond to verbal commands. The patient's recovery is also quicker. It is performed primarily on minor surgeries. The drugs used in conscious sedation are similar to general anesthesia, but the dosage is low. All the drugs have a rapid onset and short duration of effects. The side effects and after-procedure complications are minimal with conscious sedation compared to general anesthesia.
