Deep Sedation

Deep Sedation/Analgesia

What is Deep Sedation/Analgesia?

Deep sedation is an even higher level of sedation where the patient is clearly sedated and may only respond minimally to very significant stimuli (such as high levels of pain, etc.) or may not even respond at all in some cases.

Effects of Deep Sedation/Analgesia

There are two primary objectives in the process of sedation. First, sedation allows the patients to tolerate unpleasant diagnostic or surgical procedures and to relieve anxiety and discomfort. Second, sedation helps uncooperative patients expedite and simplify special procedures that need very little or no movement. Sedation is also often needed to lessen the fear associated with operative procedures.

Candidates for Deep Sedation/Analgesia

This procedure is recommended for patients who need to undergo diagnostic or surgical procedures that require deep sedation. The doses can always be adjusted as the situation demands. Another candidate for this is an agitated or confused patient who does not respond to reassurance, especially if the patient has cardiopulmonary compromise that is affected by physiologic stress.

Your Consultation

Before the administration of medications, it is essential for physicians to find out the level of sedation required for a given procedure and to provide the appropriate dose of the pharmacologic agent or agents selected. This will help determine the equipment that is needed prior to starting the procedure. Some considerations before and during sedation include periprocedural patient assessment, periprocedural fasting and monitoring.

The Deep Sedation/Analgesia Procedure

The patient should have a qualified person present who should monitor the patient’s physiologic parameters when the sedatives are being administered. But before sedation should even be initiated, sufficient interviews and explanations should be done. The contra-indications to sedation should be well thought-out in every case. Also, the monitors should be routinely in place during the application of sedation.

Recovery

After the procedure, the patient will be placed in a recovery room where the assessment of residual drug effects will take place. The recovery room monitoring will primarily focus on the patient’s heart stability, respiratory adequacy and return to previous brain functioning.

Risks

With deep sedation, the patient is not easily aroused but responds purposefully to painful stimulation. Other risks may include the patient’s inability to maintain a patent airway and the inadequacy of spontaneous ventilation.

FAQs

What happens during Deep Sedation/Analgesia?

Deep Sedation/Analgesia is a drug-induced depression of consciousness where patients cannot be easily aroused but respond purposefully to painful stimulation. During the procedure, the ability to maintain ventilatory function may be impaired. It is also possible that patients may require assistance in maintaining a patent airway, and spontaneous ventilation may not be adequate. Cardiovascular function though, is usually maintained.

Who should administer sedation?

Administering sedation is a learned skill, and just like other skills that are practiced in the delivery of healthcare, individuals handling sedation need to be trained. This training teaches skills that are necessary and gives credentials to the healthcare provider in order to make sure that they are qualified to provide sedation in a safe way.

What is unconscious sedation?

Unconscious sedation is a controlled state of anesthesia. It is characterized by partial or complete loss of protective nerve reflexes, which includes the ability to independently breathe and respond to commands. With unconscious sedation, the patient is unable to cooperate, has fluctuating vital signs, prolonged recovery room convalescence, and a higher risk of anesthetic complications.

What are some clinically relevant contraindications to sedation?

The relevant contraindications are the following:

  • conditions where there is an increased risk of pulmonary aspiration
  • the possibility of airway obstruction or respiratory irregularities
  • raised intracranial pressure, or other conditions where increased PaCO2 could be harmful
  • conditions wherein the respiratory center is desensitized to carbon dioxide
  • renal or hepatic dysfunction that may alter drug kinetics
  • unpredictable drug effect, as sedatives may heighten restlessness