Conscious sedation: what it is, how it is performed and what complications it can lead to
Conscious sedation, also called sedo-analgesia, is an anaesthesiological technique used to induce a state of relaxation, amnesia and pain control during a diagnostic or surgical procedure: the patient – who is administered anxiolytic and painkilling drugs – remains conscious but completely relaxed, feels no pain and remembers nothing of the procedure
When it is appropriate to choose conscious sedation
Conscious sedation is used for minor surgical procedures usually accompanied by local anaesthesia that do not require general anaesthesia and for certain types of instrumental examinations (such as endoscopies) that may be uncomfortable or minimally painful.
How conscious sedation is performed
Before sedation, the anaesthetist in charge of the procedure checks the patient’s medical history, who is then examined.
Sedation is performed by means of a cannula needle inserted intravenously, which is used to administer medication.
During sedation, vital parameters are constantly monitored: heart rate, blood pressure, respiratory rate, oxygen saturation.
The patient’s level of consciousness and response to stimuli is also checked every 5 minutes.
For some types of surgery, such as dental surgery for anxious patients, children and people unable to cooperate fully with the dentist, a gas called Nitrous Oxide can be associated with the drugs injected by venous route, which is mixed with Oxygen by mechanical mixers and inhaled through a nasal mask.
Once the examination is over, the patient remains under observation for about 2 hours; when discharged, he or she must be accompanied by a family member or friend and must undertake not to drive for the entire day.
Complications due to conscious sedation
Complications are mainly related to the side effects of the drugs administered.
Potential risks are related to respiratory depression, inhalation of gastric contents, cardiac complications (arrhythmias, ischaemia) and allergic reactions.
However, these complications are rare (about 1 per 1000 patients) and are generally well managed.
The level of safety of this technique is very much dependent on the experience of the operators both in assessing the patient before the procedure and in performing the technique under safe conditions and in appropriate environments.
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