CONSCIOUS
SEDATION
Dr. Khaled Khreisat
Consultant Anaesthetist
Head Of Department Of Anesthesia
At Prince Sultan Hospital
1
OUR TOPIC
TODAY WILL
DISCUSS THE
FOLLOWING
POINTS
1. Definition of sedation, and
conscious sedation
2. Patient Assessment Prior To
Conscious Sedation
3. Sedation Techniques
4. Drugs, their Effects and their
Doses
5. Pre and Post sedation instructions
2
PART 1
Definition Of
Sedation
&
Conscious
Sedation
3
What is conscious sedation?
It is a technique where one or more drugs are used to depress
the Central Nervous System of a patient thus reducing the
awareness of the patient to his surroundings.
According to the degree of Central Nervous System
depression:
• ◦ Conscious Sedation
• ◦ Deep Sedation
• ◦ General Anesthesia
4
DIFFERENCE BETWEEN CONSCIOUS AND DEEP SEDATION
5
WHOM
TO
GIVE
 To Anyone going for a painful or
uncomfortable procedure
 Diagnostic or Therapeutic procedure
 To reduce pain and anxiety
6
GOALS OF CONSCIOUS SEDATION
• Provision of safe analgesia, anxiolysis, sedation,
and amnesia during stressful procedures.
• Safely decreasing adverse psychological responses
associated with stressful procedures.
• The return of patients to their pre-procedural level
of functioning
7
WHAT ARE THE LEVELS OF CONSCIOUS SEDATION?
• Sedation Score 0 = Fully awake
• Sedation Score 1 = Light sedation, largely aware of
self/surroundings. Mildly sleepy.
• Sedation Score 2 = Moderate sedation, slightly aware of
self/surroundings; somnolent but easily aroused with stimulation.
• Sedation Score 3 = Deeply sedated; unaware of self/surroundings.
• Sedation Score 4 = General anesthesia; patient is unconscious
8
PART 2
Patient
Assessment
Prior To
Conscious
Sedation
9
PATIENT ASSESSMENT PRIOR TO CONSCIOUS SEDATION
 Perform a history and physical exam
 Assign an American Society of Anesthesiologist (ASA) health class ;
 Document a sedation plan
 Document NPO status and interval changes if History & physical
examination not done immediately prior to procedure.
10

AIRWAY ASSESSMENT;
• Mouth opening
• Airway classes according to Mallampati score;
11
PART 3
Sedation
Techniques
12
1.Non - Titrable Technique;
SEDATION
TECHNIQUES
•
•
•
•
•
Oral Sedation
Rectal Sedation
Intramuscular Sedation
Submucosal Sedation
Intranasal Sedation
2. Titrable Technique
• Inhalational Sedation
• Intravenous Sedation
3.Combination of the two techniques
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Sedation Techniques
SEDATION
TECHNIQUES
ORAL
SEDATION
By far, it is the most universally accepted and easiest method of sedation administration.
The most variable (non-titrable) technique
We should be familiar with the effects of oral sedation, such as ;
 Recovery time prolonged
 Difficult to reverse unwanted effect
 No repeated doses
15
2.INHALATION SEDATION
3. Intravenous Sedation
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THE
NECESSARY
EQUIPMENTS
&
MONITORS
•
•
•
•
Oxygen (2 outlets)
Self inflating bag, valve and mask
Suction
Emergency equipment, airway kit
(age), crash cart, defibrillator
• Pharmacological Antagonists
• BASIC STANDARD MONITORS:
• Pulse Oximeter, ECG monitor, BP,
Monitor, Capnograph
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PART 4
Drugs,
Their Effects
&
Their Doses
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Either one drug or combinations of IV
drugs
DRUGS
FOR
SEDATION
Most Common combinations :
• Benzodiazepines & opioids
• Propofol & opioids
1.Diazepam (Valium)
2.Ketamine
3.Midazolam (Versed)
4.Fentanyl (Sublimaze)
5.Propofol (Diprivan)
6.Robinul (Glycopyrrolate)
7.Naloxone (Narcan)
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PART 5
Pre & Post
Sedation
Instructions
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• Pre-Procedure Fasting (“NPO”)
PRE & POST
SEDATION
INSTRUCTIONS
The patient must be fasted
minimum 2-3 hours for clear
liquids and 6 hours for solid
food to prevent vomiting
causing suffocation and
aspiration pneumonia.
• Discharge Criteria
1. Vital signs normal (within 20%
baseline)
2. Airway patency uncompromised
3. Patient awake, or awake on
command
4. Can breathe deeply
5. Protective reflexes intact
6. Adequate hydration, able to drink
7. Patient can speak normally
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8. Patient can sit unaided
9. Patient can walk with minimal
assistance
10.Responsible adult is available
11.No pain, no nausea or vomiting
POSTSEDATION
INSTRUCTIONS
Verbal and written instructions
must be given to the adult upon
discharge from the office should
include:
1.
2.
3.
4.
5.
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Potential and anticipated postsedation effects
Limitation of activity (driving,
machinery) for 24 hrs
Dietary precautions and
suggestions
No other sedatives for 24 hrs
24-hour contact number for
practitioner
THANK YOU FOR LISTENING
BEST WISHES!