sedation


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Related to sedation: Conscious sedation

Sedation

 

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.

Preparation

Usually procedures for conscious sedation do not require preoperative or pre-testing orders. Clinical situations for unconscious sedation typically involve eating and drinking protocols starting the day before the procedure.
The age and physical status of the patient is useful in determining sensitivity. A detailed past history, especially prior experiences with sedatives and other anesthetics is an important part of preparatory assessment. It is important to determine if there were any untoward side effects associated with a previous medication. Patient positioning is important to prevent blood pressure changes or nerve damage associated with abnormal position.
Patients are also monitored for pulse rate, respiration, blood pressure, and temperature. Additionally, the heart is monitored using electrocardiography (ECG). Ventilation is assessed using a pulse oximeter. This machine is clipped with a special probe on one finger and can measure the levels of oxygen and carbon dioxide, which are reliable indicators of respiratory status.

Aftercare

The major goal for recovery room monitoring is assessment of residual drug effects. Recovery room monitoring primarily focuses on heart stability, respiratory adequacy and return to previous brain functioning.

Risks

The original forms of diazepam (Valium, a very common sedative) caused irritation of veins and phlebitis. Newer forms of diazepam (Dizac) are chemically improved to lower the possibility of vein irritation. Age and physical health are important risk factors. Preexisting medical conditions such as high blood pressure and heart and lung disease may increase the chance of developing undesirable side effects.

Normal results

Normal or uncomplicated results for sedation include alleviation of anxiety and discomfort. Coupled with analgesic, patients are usually pain-free. The normal progression post procedure or post operatively would be to return to baseline brain functioning, unassisted breathing, and normal heart rate and rhythm.

Abnormal results

Patients may have excessive nausea and vomiting associated with narcotic analgesia (if this is indicated). Excessive drowsiness can occur secondary to benzodiazepine-induced sedation. The patient can also develop hypoventilation (a decrease in ventilation), airway obstruction, high or low blood pressure, abnormal heart rhythms, nausea, vomiting, and shivering.

Key terms

Baseline — A return to an original state.
Diazepam — One of the most commonly used sedative-hypnotic medications.

Resources

Books

Fleisher, Gary R., et al. Textbook of Pediatric Emergency Medicine. 4th ed. Lippincott Wlliams & Wilkins, 2000.
Miller, Ronald D., et al, editors. Anesthesia. 5th ed. Churchill Livingstone, Inc., 2000.

sedation

 [sĕ-da´shun]
1. the allaying of irritability or excitement, especially by administration of a sedative.
2. the state so induced.
conscious sedation in the nursing interventions classification, a nursing intervention defined as administration of sedatives, monitoring of the patient's response, and provision of necessary physiological support during a diagnostic or therapeutic procedure.

se·da·tion

(sĕ-dā'shŭn),
1. The act of calming, especially by the administration of a sedative.
2. The state of being calm.
[L. sedatio, to calm, allay]

sedation

/se·da·tion/ (sĕ-da´shun)
1. the allaying of irritability or excitement, especially by administration of a sedative.
2. the state so induced.

conscious sedation  a state of anesthesia in which the patient is conscious but is rendered free of fear and anxiety.

sedation

(sĭ-dā′shən)
n.
1. Reduction of anxiety, stress, irritability, or excitement by administration of a sedative agent or drug.
2. The state or condition induced by a sedative.

sedation

[sidā′shən]
Etymology: L, sedatio, soothing
an induced state of quiet, calmness, or sleep, as by means of a sedative or hypnotic medication.

sedation

The production/induction of a sedative state. See Conscious sedation, Terminal sedation.

se·da·tion

(sĕ-dā'shŭn)
1. The act of calming, especially by the administration of a sedative.
2. The state of being calm.
[L. sedatio, fr. sedo, pp. sedatus to calm, allay]

sedation

The use of a mild drug to calm, alleviate anxiety and promote sleep.

se·da·tion

(sĕ-dā'shŭn)
The act of calming, especially with a sedative.
[L. sedatio, to calm, allay]

sedation (sedā´shən),

n the production of a sedative effect; the act or process of calming.
sedation, conscious,
n a condition induced by drugs or other means in which the patient retains a minimum level of consciousness while continuing to breathe on his or her own and to respond to verbal and physical prompts.
sedation, deep,
n a condition induced by drugs or other means in which the patient enters a temporary state of semiconsciousness, causing partial loss of sensory perception and the inability to respond to verbal prompts.

sedation

1. the allaying of irritability or excitement, especially by administration of a sedative.
2. the state so induced.

sedation points
in acupuncture used to decrease energy in a specific organ or a meridian.
References in periodicals archive ?
To the contrary, if ADA Resolution 77 is approved, it will drive hundreds of thousands of patients away from seeing a dentist altogether because the costs of many basic sedation dentistry services will double.
The research also helps review key players involved in the therapeutics development for Sedation and enlists all their major and minor projects.
There's still not a lot of good data about it for agitated patients in the ED, though there's tons of data for procedural sedation.
Reports mentioned that medically-induced coma can be induced by powerful anaesthetics and is broadly similar to the sedation and artificial ventilation used during surgery and it is used to shut down many brain functions and so lower blood flow and pressure.
In addition to standard-of-care monitoring of vital signs, sedation levels were monitored with the Ramsay Sedation Scale (RSS) (Table 1), and brain function was monitored using the Patient State Index (PSI) obtained from a brain function monitor (Hospira, Inc.
The 2013 updated American College of Critical Care Medicine guidelines (11) on pain, agitation and delirium management in critically ill adults made two important recommendations: delivering analgesia before sedation and the provision of light sedation whenever clinically appropriate.
10 After knowing the facts about nausea and vomiting it needs to observe as variable in those cases that have been done in monitored anaesthesia care or deep sedation.
The selection was of children that attended the sedation assessment clinic, randomly selected based on the availability of the researcher (EA).
Certified child-life specialist--A certified child-life specialist was hired to prepare, coach, distract, and support children in an attempt to increase the likelihood that a child would be able to cooperate during the acquisition of CT or MRI studies without sedation (Figure 1).
Propofol (Diprivan 1%, AstraZeneca Pharmaceuticals, Mississauga, Canada) infusion was started for sedation at 1.
We take the time to discuss anxieties and review relaxation options, including sedation techniques.
The champion of sedation dentistry is Michael Silverman, who founded the 2,600-member, for-profit Dental Organization for Conscious Sedation in 2000.