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Sedation is the reduction of irritability or agitation by administration of
sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but ...
drugs, generally to facilitate a
medical procedure A medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagnosing a patient condition or parameter is also called a medical test. ...
or diagnostic procedure. Examples of drugs which can be used for sedation include
isoflurane Isoflurane, sold under the brand name Forane among others, is a general anesthetic. It can be used to start or maintain anesthesia; however, other medications are often used to start anesthesia rather than isoflurane, due to airway irritation ...
,
diethyl ether Diethyl ether, or simply ether, is an organic compound in the ether class with the formula , sometimes abbreviated as (see Pseudoelement symbols). It is a colourless, highly volatile, sweet-smelling ("ethereal odour"), extremely flammable li ...
,
propofol Propofol, marketed as Diprivan, among other names, is a short-acting medication that results in a decreased level of consciousness and a lack of memory for events. Its uses include the starting and maintenance of general anesthesia, sedation f ...
,
etomidate Etomidate (USAN, INN, BAN; marketed as Amidate) is a short-acting intravenous anaesthetic agent used for the induction of general anaesthesia and sedation for short procedures such as reduction of dislocated joints, tracheal intubation, cardiove ...
,
ketamine Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a recreational drug. It is one of the safest anesthetics, as, in contrast with opiates, ether, and propofol, it suppress ...
, pentobarbital,
lorazepam Lorazepam, sold under the brand name Ativan among others, is a benzodiazepine medication. It is used to treat anxiety disorders, trouble sleeping, severe agitation, active seizures including status epilepticus, alcohol withdrawal, and che ...
and midazolam.


Medical uses

Sedation is typically used in minor surgical procedures such as
endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inse ...
, vasectomy, or dentistry and for reconstructive surgery, some cosmetic surgeries, removal of wisdom teeth, or for high-anxiety patients. Sedation methods in dentistry include
inhalation sedation Inhalation sedation is a form of conscious sedation where an inhaled drug should: # Depress the central nervous system (CNS) to an extent that surgeons can operate with minimal physiological and psychological stress to the patient # Modify the pati ...
(using
nitrous oxide Nitrous oxide (dinitrogen oxide or dinitrogen monoxide), commonly known as laughing gas, nitrous, or nos, is a chemical compound, an oxide of nitrogen with the formula . At room temperature, it is a colourless non-flammable gas, and ha ...
), oral sedation, and intravenous (IV) sedation.
Inhalation sedation Inhalation sedation is a form of conscious sedation where an inhaled drug should: # Depress the central nervous system (CNS) to an extent that surgeons can operate with minimal physiological and psychological stress to the patient # Modify the pati ...
is also sometimes referred to as ''relative analgesia''. Sedation is also used extensively in the
intensive care unit 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensi ...
so that patients who are being ventilated tolerate having an
endotracheal tube A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes ar ...
in their
trachea The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air- breathing animals with lungs. The trachea extends from t ...
. It can also be used during a long term brain EEG to help patient relax.


Risks

There are studies claiming that sedation accounts for 40 percent to 50 percent procedure-related complications.
Airway obstruction Airway obstruction is a blockage of respiration in the airway that hinders the free flow of air. It can be broadly classified into being either in the upper airway (UPA) or lower airway (LOA). Airway obstruction is a life-threatening condition ...
,
apnea Apnea, BrE: apnoea, is the temporal cessation of breathing. During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the airways are ( patency), there ma ...
and
hypotension Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the di ...
are not uncommon during sedation and require the presence of
health professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...
s who are suitably trained to detect and manage these problems. Aside from the suppression of respiration, risks also include unintended levels of sedation, postoperative
somnolence Somnolence (alternatively sleepiness or drowsiness) is a state of strong desire for sleep, or sleeping for unusually long periods (compare hypersomnia). It has distinct meanings and causes. It can refer to the usual state preceding falling asleep ...
, aspiration, and adverse reactions to sedation medications. Complications could also include perforation, bleeding, and the stimulation of vasovagal reflexes. 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 difficult
airway management Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either cl ...
. This process can also reveal if the sedation period needs to be prolonged or additional therapeutic procedures are required.


Levels of sedation

Sedation scales are used in medical 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) and over-sedation (the patient risks side effects such as suppression of breathing, which might lead to death). 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 Richmond Agitation-Sedation Scale (RASS) is a medical scale used to measure the agitation or sedation level of a person. It was developed with efforts of different practitioners, represented by physicians, nurses and pharmacists. The RASS can be ...
). The American Society of Anesthesiologists defines the continuum of sedation as follows: * 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 of
general anesthesia General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
, 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 of osteoporosis.


Intravenous sedation

The most common standard conscious sedation technique for adults is intravenous sedation using Midazolam. This requires a needle to be put into a vein to deliver the medication; this is known as an IV cannula. Indications: * Reduced dental anxiety and phobia * 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: * 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 * CNS depressant medications which can alter reaction to sedation


See also

*
Palliative sedation In medicine, specifically in end-of-life care, palliative sedation (also known as terminal sedation, continuous deep sedation, or sedation for intractable distress of a dying patient) is the palliative practice of relieving distress in a terminally ...
*
Procedural sedation Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decr ...
* Twilight anesthesia *
Inhalation sedation Inhalation sedation is a form of conscious sedation where an inhaled drug should: # Depress the central nervous system (CNS) to an extent that surgeons can operate with minimal physiological and psychological stress to the patient # Modify the pati ...


References

{{Authority control Anesthesia