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Sedation

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Reduction of irritability or agitation by administration of sedative drugs

Not to be confused withsedition orseduction.

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Sedation is the reduction ofirritability or agitation by administration ofsedative drugs, generally to facilitate amedical procedure or diagnostic procedure. Examples of drugs which can be used for sedation includeisoflurane,diethyl ether,propofol,etomidate,ketamine,pentobarbital,lorazepam andmidazolam.^[1]

Medical uses

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Sedation is typically used in minor surgical procedures such asendoscopy,vasectomy, ordentistry and for reconstructive surgery, some cosmetic surgeries, removal ofwisdom teeth, or for high-anxiety patients.^[2] Sedation methods indentistry includeinhalation sedation (usingnitrous oxide), oral sedation, and intravenous (IV) sedation. Inhalation sedation is also sometimes referred to as "relative analgesia".^{[citation needed]}

Sedation is also used extensively in theintensive care unit so that patients who are beingventilated tolerate having anendotracheal tube in theirtrachea. It can also be used during a long term brainEEG to help patient relax.^{[citation needed]}

Risks

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There are studies claiming that sedation accounts for 40 percent to 50 percent procedure-related complications.^[3]Airway obstruction,apnea, andhypotension are not uncommon during sedation and require the presence ofhealth professionals who are suitably trained to detect and manage these problems. Aside from therespiratory depression, risks also include unintended levels of sedation, postoperativesomnolence, aspiration,^[4] and adverse reactions to sedation medications.^[5] Complications could also include perforation, bleeding, and the stimulation ofvasovagal reflexes.^[6] To avoid sedation risks, care providers conduct a thorough pre-sedation evaluation and this process includes pre-sedation history and physicals with emphasis on the determining characteristics that indicate potential risks to the patient and potential difficultairway management.^[7] This process can also reveal if the sedation period needs to be prolonged or additional therapeutic procedures are required.^[8]

Levels of sedation

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Sedation scales are used inmedical situations in conjunction with a medical history in assessing the applicable degree of sedation in patients in order to avoid under-sedation (the patient risks experiencing pain or distress) andover-sedation (the patient risks side effects such as suppression of breathing, which might lead to death).^{[citation needed]}

Examples of sedation scales include MSAT (Minnesota Sedation Assessment Tool), UMSS (University of Michigan Sedation Scale), the Ramsay Scale (Ramsay, et al. 1974) and the RASS (Richmond Agitation-Sedation Scale).^{[citation needed]}

TheAmerican Society of Anesthesiologists defines the continuum of sedation as follows:^[9]

Minimal sedation – normal response to verbal stimuli.
Moderate sedation – purposeful response to verbal/tactile stimulation. (This is usually referred to as "conscious sedation")
Deep sedation – purposeful response to repeated or painful stimulation.
General anesthesia – unarousable even with painful stimulus.

In the United Kingdom, deep sedation is considered to be a part of the spectrum ofgeneral anesthesia, as opposed to conscious sedation.

In addition to the aforementioned precautions, patients should be interviewed to determine if they have any other condition that may lead to complications while undergoing treatment. Any head, neck, or spinal cord injuries should be noted as well as any diagnosis ofosteoporosis.^{[citation needed]}

Intravenous sedation

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The most common standard conscious sedation technique for adults is intravenous sedation usingMidazolam.

Indications:^{[citation needed]}

Reduced dental anxiety andphobia
Traumatic or prolonged dental procedures
Patients with gag reflex
Medical conditions potentially aggravated by the stress of dental treatment
Special care (mild intellectual or physical disability)
Some disorders involving its spasticity due to its muscle relaxant properties

Contraindications:^{[citation needed]}

Uncooperative patient
Psychologically immature individuals
Patients unable to provide a suitable escort
Difficult oral surgery or prolonged surgical procedure
Muscle diseases or diseases which cause muscle wastage
ASA III or above
Allergy or hypersensitivity to benzodiazepines
Pregnancy and breast feeding
History of psychiatric disorders
Kidney or liver dysfunction
Acute pulmonary insufficiency
Preexisting respiratory conditions as patients are susceptible to respiratory depression
Alcohol or drug addiction
Lack of visible superficial veins

Sedation for pediatric patients

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Present drugs commonly used to sedate children:Methohexital;Thiopental;Benzodiazepines;Diazepam;Midazolam;Ketamine;Opioids;Morphine;Meperidine;Fentanyl.

Whenever it is necessary to sedate a child, one must consider the type of procedure planned (painful or nonpainful), the duration of the procedure (important in choosing the appropriate sedative), the underlying medical condition of the patient (proper fasting, contracted blood volume, interaction with other medications, and intact mechanisms of drug elimination), the need foranxiolysis ornarcosis, and experience with alternative techniques or routes of administration.

A child undergoing a procedure that is nonpainful (e.g., CT scan or small laceration infiltrated with local anesthetic) does not require a narcotic. Conversely, a child undergoing a painful procedure may require an opioid.^[10]

References

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^Brown, TB.; Lovato, LM.; Parker, D. (Jan 2005). "Procedural sedation in the acute care setting".Am Fam Physician.71 (1):85–90.PMID 15663030.
^"Sedation Dentistry for Anxious Patients". Archived fromthe original on 2014-09-23. Retrieved2014-09-11.
^Vargo, John (2016).Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America. Philadelphia, PA: Elsevier Health Sciences. p. 465.ISBN 9780323448451.
^Odom-Forren, Jan; Watson, Donna (2005).Practical Guide to Moderate Sedation/analgesia. St. Louis, MO: Elsevier Mosby. p. 84.ISBN 0323020240.
^Vargo, John (2016).Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America. Philadelphia, PA: Elsevier Health Sciences. p. 554.ISBN 9780323448451.
^Skelly, Meg; Palmer, Diane (2006).Conscious Sedation: A Handbook for Nurse Practitioners. London: Whurr Publishers. pp. 69].ISBN 1861562667.
^Mason, Keira (2011).Pediatric Sedation Outside of the Operating Room: A Multispecialty International Collaboration. New York: Springer. p. 166.ISBN 9780387097138.
^Winter, Harland; Murphy, Stephen; Mougenot, Jean Francois; Cadranel, Samy (2006).Pediatric Gastrointestinal Endoscopy: Textbook and Atlas. Hamilton, Ontario: BC Decker Inc. p. 59.ISBN 1550092235.
^"Continuum of Depth of Sedation: Definition of general anesthesia and levels of sedation/analgesia".American Society of Anesthesiologists. 21 October 2009. Archived fromthe original(pdf) on 2010-11-20. Retrieved2010-11-29.
^Coté, Charles J. (February 1994)."Sedation for the Pediatric Patient: A Review".Pediatric Clinics of North America.41 (1):31–58.doi:10.1016/S0031-3955(16)38690-4.