Conscious sedation induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives. Patients who receive conscious sedation usually are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider.
Conscious sedation provides a safe, effective option for patients undergoing minor surgeries or diagnostic procedures. The number and type of procedures that can be performed using conscious sedation have increased significantly as a result of new technology and state-of-the-art drugs.
Conscious sedation allows patients to recover quickly and resume normal daily activities in a short period of time. A brief period of amnesia may erase any memory of the procedure.
Conscious sedation is the use of medication to minimally depress the level of consciousness in a patient while allowing the patient to continually and independently maintain a patent airway and respond appropriately to verbal commands and/or gentle stimulation. This type of sedation is being used more and more frequently for a variety of diagnostic and surgical procedures. The ability to independently maintain a patent airway is an important distinguishing feature of conscious sedation. Conscious sedation of the patient is generally achieved when there is an onset of slurred speech. Another type of sedation, deep sedation or Monitored Anesthesia Care (MAC),uses medication to induce a controlled state of depressed consciousness or unconsciousness in which the patient may experience partial or complete loss of protective reflexes including the ability to independently and continuously maintain a patent airway. The deeply sedated patient may not be easily aroused and may not purposefully respond to verbal commands or physical stimulation. This deep sedation may be administered by anesthesiologists only. It should be recognized that various degrees of sedation occur on a continuum. A patient may progress from one degree of sedation to another depending on their underlying medical status, the medication(s) administered, dosage and route of administration. It is important therefore that the monitoring and staffing requirements be based on the patient's acuity and the potential response of the patient to the procedure. Progress from one level of sedation to another requires appropriate changes in monitoring and observation of the patient.
The responsibilities of those care providers, physician, dentist or nurse, administering conscious sedation is to prepare and monitor the patient before, during and after the procedure. Informed consent must be obtained prior to the procedure and prior to the patient receiving sedating medication. For outpatient procedures, before sedating the patient, discharge and follow up instructions may need to be given to the patient and/or the person responsible for transporting the patient post-sedation.
Monitoring Conscious Sedation
Because patients can slip into a deep sleep, proper monitoring of conscious sedation is necessary. Healthcare providers monitor the patient's heart rate, blood pressure, breathing, oxygen level and alertness throughout and after the procedure. It is important that the provider who monitors the patient receiving conscious sedation has no other responsibilities during the procedure and remains with the patient at all times during the procedure.
A qualified provider monitors the patient immediately following the procedure. Written postoperative care instructions should be given to the patient to take home. Patients should not drive a vehicle, operate dangerous equipment or make any important decisions for at least 24 hours after receiving conscious sedation. A follow-up phone call usually is made by the healthcare provider to check on the patient's condition and answer any remaining questions.
A brief period of amnesia after the procedure may follow the administration of conscious sedation. Occasional side effects may include headache, hangover, nausea and vomiting or unpleasant memories of the surgical experience.