Twilight Anesthesia - Uses, Advantages, and Disadvantages

Introduction

Considering the need for general anesthesia, some individuals hesitate to have cosmetic surgery. There are drawbacks to general anesthesia, including the requirement for breathing assistance or ventilation, nausea-related side effects, and higher expenditures. Twilight anesthesia is an alternative to general anesthesia. The patient is in a "twilight state" during surgery or other medical operations, where they are relaxed and "sleepy," able to follow basic instructions from the doctor, and responsive. It is considered a conventional anesthetic intended to make a patient more comfortable and lessen any pain related to the surgery being performed without any disturbance. According to the American College of Emergency Physicians (ACEP), twilight anesthesia is a "method of administering sedatives or dissociative medications with or without analgesics to generate a state that allows the patient to undergo unpleasant operations while maintaining the cardiorespiratory function”.

What Is Anesthesia?

Anesthesia is a state of controlled, momentary loss of sensation or awareness that is induced. Which causes sleep or numbness in certain body parts to perform general surgery without any disturbance. Additionally, it reduces discomfort and pain to the patient while performing the surgical intervention. It is classified into two types:

• General Anesthesia: General anesthesia, which makes patients completely asleep and unaware of the operation, is frequently employed for more complicated procedures.

• Local Anesthesia: Only a small portion of the body is anesthetized while the patient is completely conscious. This is frequently done for simple procedures.

What Are the Levels of Anesthesia?

Twilight Anesthesia is broadly distinguished into four levels:

• Level 1: Anxiolysis, a drug-induced state in which the patient reacts normally to verbal commands, it is called level one or minor sedation. Cardiovascular and respiratory functions remain unchanged, despite the patient's compromised cognition and coordination ability.

• Level 2: This stage, also known as conscious sedation or moderate sedation, or analgesia, results in a drug-induced depression of consciousness during which the patient consciously responds to verbal commands, either on their own or in conjunction with light physical stimulation. For this kind of anesthesia, breathing tubes are not necessary. It is called twilight anesthesia.

• Level 3: Deep sedation or analgesia, is a drug-induced depression of consciousness in which the patient cannot be easily woken yet responds consciously to persistent or painful stimulation. Breathing tubes are needed because respiratory functions could be compromised. Typically, cardiovascular functions remain unchanged.

• Level 4: This level of drug-induced unconsciousness, known as general anesthesia, prevents the patient from being awakened even by painful stimulation. Cardiovascular functions can also be affected, as well as respiratory function.

What Is Twilight Anesthesia?

Twilight is the state where the patient is asleep but awake with the use of low doses of medicines to temporarily impair memory, ease anxiety, and block pain, allowing patients to feel at ease both during and after surgery. The patient remains alert and is able to follow instructions or interact with the doctor. Moreover, it is frequently used in conjunction with a local anesthetic that is given to the surgical site to guarantee that the patient has a pain-free experience. Fentanyl, Valium, Ketamine, Midazolam, or Nitrous oxide are employed in twilight anesthesia that is frequently utilized as laughing gas. These medications are easily reversed, allowing the patient to be awakened in a matter of minutes.

What Are the Drugs Used in Twilight Anesthesia?

Twilight anesthesia uses some similar medications as general anesthesia, although in smaller concentrations and during a short timespan a concentrated mass of a substance administered intravenously for diagnostic or therapeutic purposes. The common drugs which can be administered intravenously are:

• Ketamine is mainly used in kids and rarely in adults.

• Propofol.

• Midazolam.

• Nitrous oxide or laughing gas.

Twilight anesthesia is usually administered alongside a local or regional anesthetic because it cannot be utilized to treat surgical pain on its own. Moreover, the previously mentioned medications for establishing and maintaining anesthesia are sometimes combined with a benzodiazepine, typically Midazolam, but Temazepam or Flunitrazepam are also used to create IV (intravenous) sedation.

What Is the Difference Between Twilight and General Anesthesia?

The level of patient consciousness is the main distinction between general anesthesia and twilight anesthesia.

Patients who undergo general anesthesia are brought into an induced coma which makes them fully unconscious and causes the loss of reflexes and autonomic nervous system control. Patients who receive general anesthesia must need breathing tubes and a ventilator to assist them to breathe since general anesthesia can impede a patient's ability to move their muscles normally.

In contrast, twilight anesthesia individuals remain semi-conscious, and ventilation is not necessary.

What Are the Uses Of Twilight Anesthesia?

Several kinds of operations and medical procedures use twilight anesthesia which reduces postoperative nausea and shortens the recovery period. Most are employed in minor plastic surgery and dental treatment. Other procedures which utilize twilight anesthesia are listed below:

• Liposuction.

• Breast Augmentation.

• Blepharoplasty or eyelid surgery.

• Chin Implant.

• Laser Resurfacing.

• Facelift.

What Are the Advantages of Twilight Anesthesia?

• Twilight sedation does not cause complete unconsciousness; therefore recovery is typically quicker and simpler than recovery after general anesthesia.

• Decreased rate of complications and adverse effects in comparison with general anesthesia (GA).

• Cost-effective: it is economically less expensive than a GA.

• No ventilation is necessary.

• Average recovery times that are faster.

• Decreased nausea and vomiting caused by the anesthetic.

What Are the Disadvantages of Twilight Anesthesia?

Both local and general anesthetics subside after a few hours of use. The patient might feel nauseous, dizzy, faint, cold, or curiously itching after waking from an anesthetic, although these side effects normally don't last for very long. The most frequent adverse reactions include headaches, bruises, discomfort, and pains. After anesthesia, blurred vision, numbness, weakness, twitching muscles, and a "pins and needles" sensation are all frequent side effects. And some individuals can report temporary trouble urinating. These feelings, though unpleasant, will typically go away when the nerves "wake up" once more and resume normal communication with the brain.

Conclusion

Twilight sedation is a treatment used to treat in a conscious state; it shouldn't be viewed as a substitute for reliable local anesthetic or skillful behavioral control. The medicine and route of administration are adjusted for each patient separately. The favorable outcome is achieved by workers who are properly trained, working in an environment with sufficient monitoring equipment, and conducting thorough predatory assessments. The goal of twilight sedation is to provide a low state of consciousness that enables the patient to autonomously maintain their oxygenation and airway control.