Sedation is about calming down and calming down the patient. Consciousness may be slightly disturbed after its application, although patients usually do not lose it completely. Sedation is used in various minor surgical procedures, but also during diagnostic procedures, e.g. during bronchoscopy. Sedation is sometimes an alternative to general anesthesia, but one question remains: is it safe? What are the side effects of sedation?

Sedationis primarily aimed at calming and relaxing the patients. This state is achieved by reducing the activity of the central nervous system structures through the use of pharmacological agents. It is characteristic of sedation that the patient may remain aware of it, which is impossible with general anesthesia.

It should be remembered that various drugs that are used in sedation may have other effects - apart from the above-mentioned ones - among which there is an analgesic effect (i.e. the relief of pain in patients). In addition, some sedative preparations lead to the occurrence of amnesia in patients.

Sedation: types

There are several levels of sedation:

  • plaque sedation: in its course, the patient has slow reactions to various stimuli, is relaxed, but is fully conscious
  • Moderate sedation: In this type of sedation, the patient's awareness may be partially depleted (usually the patient is asleep), however, he is able to respond to sound stimuli (e.g. requests from medical personnel) or to pain stimuli. Various reflexes, such as the cough reflex as well as spontaneous breathing, are preserved
  • deep sedation: during this sedation, patients' awareness is essentially diminished (they are asleep), however, they may react to stronger stimuli (e.g. pain). With deep sedation, the patient's reflexes and his own breathing may be suppressed. Deep sedation is close to general anesthesia

Sedation: application

Sedation is mainly used for short-term and low-interference medical procedures, such as, for example, bone adjustment after a fracture or tooth extraction. Sedation is also increasingly used during various diagnostic procedures -especially those that do not need to be performed under general anesthesia, and at the same time are usually simply unpleasant for patients. Examples of tests where sedation is used include colonoscopy, bronchoscopy, lumbar puncture and bone marrow biopsy.

Sedationcan be used both in adults andin children . Some tests - such as, for example, computed tomography or magnetic resonance imaging - require that the patient remains motionless for some time to obtain a reliable and diagnostically worthwhile result.

Magnetic resonance imaging can sometimes take up to several dozen minutes, therefore - in order to ensure that the child is not nervous during the examination and that it really remains motionless - sedation is often used to perform various imaging tests in children .

Sedation: how to prepare for sedation?

A very detailed medical history is collected before any form of anesthesia, including sedation, is used. This is to estimate the risks that may arise during the administration of anesthesia and enables the selection of sedative medications that are appropriate for the patient.

Before sedation, the patient should inform the doctor about all he alth problems. However, it is especially important to provide the doctor with information about such problems as:

  • hypertension
  • cardiovascular diseases
  • allergies (especially if the patient is allergic to any medications)
  • renal dysfunction
  • neurological diseases (mainly having a stroke or experiencing attacks of transient ischemia of the central nervous system - the so-called TIA)
  • neuromuscular conditions (e.g. muscular dystrophy)
  • chronic pharmacotherapy (inform your doctor about the pharmaceuticals you use, but also about natural preparations - even herbal ones)

Sedation: sedative medications

In sedation, many different preparations are used, which belong to different groups of drugs and have different effects. Assedative drugsare used, for example, midazolam or lorazepam, belonging to the group of benzodiazepines. Nitrous oxide is also used in sedation, as well as opioid drugs (e.g. fentanyl), as well as ketamine, propofol and etomidate.

Sedatives can be administered by various routes, such as by inhalation (such as nitrous oxide), intravenous, and even orally. Theintravenous sedationis the most commonly used, because medications given in this way start quicklywork. It is also possible to quite precisely control the degree of sedation caused by them.

Individual of the drugs mentioned above are often used in various combinations in order to obtain sedation. So far, there has been no ideal sedative agent that would exert all the actions needed during anesthesia. Some sedative medications have a greater positive analgesia effect.

Others, on the other hand, have a greater tendency to induce oblivion, but are less prone to pain. Ultimately, the choice of specific sedative preparations and their doses depends, among others, on on the patient's age and general he alth.

Is sedation safe? Side effects of sedation

Sedation- just like other forms of anesthesia - is not without the risk of developing various he alth problems in patients. Especially in sedated patients, there is a risk of

  • apnea
  • airway obstruction
  • drop in blood pressure (hypotension)

An allergic reaction to the medications used during sedation is also possible. Another risk of sedation is the risk of ingestion of food from the gastrointestinal tract into the lumen of the respiratory tract. For this reason, patients should be fasting.

For these reasons, should patients be afraid of sedation? Not necessarily, because the patients are sedated and then controlled, usually by anesthesiologists who perform various forms of anesthesia on a daily basis. If the specialist is aware of the risks associated with a given anesthesia, firstly, he / she is able to detect such problems and, secondly, he / she knows what to do in such a situation.

It is worth knowing that the risks associated with sedation may arise, for example, as a result of the use of too high doses of sedative drugs. However, in some of these preparations there are agents that counteract the sedative effects of drugs. This is the case, for example, with benzodiazepines, the effects of which can be reversed by administering flumazenil to the patient, or with drugs from the opioid group, which stop working after the patient is given naloxone.

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About the authorBow. Tomasz NęckiA graduate of the medical faculty at the Medical University ofPoznan. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

Category:

Neurology