Sedation

Overview :

The future of anesthetic care involves the simultaneous administration of several drugs including IV medications and inhaled anesthetics. An extensive survey of death in 100,000 cases published in 1988 revealed that death within seven days was 2.9 times greater when one or two anesthetic drugs were used than when using three or more medications. As of 2000 this study is accepted as standard practice and multiple IV anesthetics is the preferable recommendation for optimal patient care.

The procedure for sedation is usually explained to the patient by an attending clinician. An IV access line is set in place for fluid replacement and injection of medications. A history is usually taken to assess risk and choice of medication. The patient typically signs consent forms and the possible side effects are explained. The day before the test, the patient may be required to maintain specified dietary restriction.

For outpatient surgery there are two types of sedation, conscious and unconscious sedation. Patients receiving conscious sedation are capable of rational responses, and they are able to maintain their airway for ventilation. The hallmark of conscious sedation is that it does not alter respiratory, cardiac, or reflex functions (nerve reflexes from the brain) to the level that requires external support for these vital functions. Patients receiving conscious sedation are cooperative, have stable vital signs (pulse, respiratory rate, and temperature), shorter recovery room convalescence, and lower risk of developing drug-induced complications. Unconscious sedation is a controlled state of anesthesia, characterized by partial or complete loss of protective nerve reflexes, including the ability to independently breathe and respond to commands. The patient is unable to cooperate, has labile (fluctuating) vital signs, prolonged recovery room convalescence, and higher risk of anesthetic complications.