Sedation Health Article

Definition

Sedation is the act of calming by administration of a sedative. A sedative is a medication that commonly induces the nervous system to calm.

Purpose

The process of sedation has two primary intentions. First, sedation is recommended to allow patients the ability to tolerate unpleasant diagnostic or surgical procedures and to relieve anxiety and discomfort. Second, sedation for uncooperative patients may expedite and simplify special procedures that require little or no movement. Additionally, sedation is often desirable to diminish fear associated with operative procedures. Sedation is typically used for common diagnostic tests that require prolonged immobilization such as magnetic resonance imaging (MRI) and computed axial tomography (CAT) scanning. Some cases that require sedation may also necessitate the use of analgesics to decrease pain associated with a procedure or test.

Precautions

Benzodiazepines (common sedative medication) have a cumulative effect. This means that if the patient has not had time to metabolize the previous dose and ingests more, then the sedative effect may increase. Because of these additive effects these medications taken with other sedatives or alcohol (also a sedative hypnotic drug) may increase chances for accidental death. In general, most of the medications that induce sedation may alter breathing and cardiac stability. In patients with preexisting lung and/or heart disease, these medications should be monitored closely or not prescribed.

Description

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.