Editing Sedation

{{short description|Reduction of irritability or agitation by administration of sedative drugs}}
{{Distinguish|sedition|seduction}}
{{more citations needed|date=February 2022}}
[[File:Anesthesiologist.jpg|thumb|Anesthetist]]
'''Sedation''' is the reduction of [[irritability]] or agitation by administration of [[sedative]] drugs, generally to facilitate a [[medical procedure]] or diagnostic procedure. Examples of drugs which can be used for sedation include [[isoflurane]], [[diethyl ether]], [[propofol]], [[etomidate]], [[ketamine]], [[pentobarbital]], [[lorazepam]] and [[midazolam]].<ref>{{Cite journal |last1=Brown |first1=TB. |last2=Lovato |first2=LM. |last3=Parker |first3=D. |title=Procedural sedation in the acute care setting |journal=Am Fam Physician |volume=71 |issue=1 |pages=85–90 |date=Jan 2005 |pmid=15663030}}</ref>

==Medical uses==
Sedation is typically used in minor surgical procedures such as [[endoscopy]], [[vasectomy]], or [[dentistry]] and for reconstructive surgery, some cosmetic surgeries, removal of [[wisdom teeth]], or for high-anxiety patients.<ref>{{cite web |url=http://www.honoluludentalpractice.com/services/sedation-dentistry-honolulu/ |title=Sedation Dentistry for Anxious Patients |access-date=2014-09-11 |archive-date=2014-09-23 |archive-url=https://web.archive.org/web/20140923110320/http://www.honoluludentalpractice.com/services/sedation-dentistry-honolulu/ |url-status=dead}}</ref> Sedation methods in [[dentistry]] include [[inhalation sedation]] (using [[nitrous oxide]]), oral sedation, and intravenous (IV) sedation. Inhalation sedation is also sometimes referred to as "relative analgesia".{{citation needed|date=February 2022}}

Sedation is also used extensively in the [[intensive care unit]] so that patients who are being [[mechanical ventilation|ventilated]] tolerate having an [[endotracheal tube]] in their [[vertebrate trachea|trachea]]. It can also be used during a long term brain [[EEG]] to help patient relax.{{citation needed|date=February 2022}}

==Risks==
There are studies claiming that sedation accounts for 40 percent to 50 percent procedure-related complications.<ref>{{Cite book |title=Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America |last=Vargo |first=John |publisher=Elsevier Health Sciences |year=2016 |isbn=9780323448451 |location=Philadelphia, PA |pages=465}}</ref> [[Airway obstruction]], [[apnea]], and [[hypotension]] are not uncommon during sedation and require the presence of [[health professional]]s who are suitably trained to detect and manage these problems. Aside from the [[respiratory depression]], risks also include unintended levels of sedation, postoperative [[somnolence]], aspiration,<ref>{{Cite book |title=Practical Guide to Moderate Sedation/analgesia |last=Odom-Forren |first=Jan |last2=Watson |first2=Donna |publisher=Elsevier Mosby |year=2005 |isbn=0323020240 |location=St. Louis, MO |pages=84}}</ref> and adverse reactions to sedation medications.<ref>{{Cite book |title=Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America |last=Vargo |first=John |publisher=Elsevier Health Sciences |year=2016 |isbn=9780323448451 |location=Philadelphia, PA |pages=554}}</ref> Complications could also include perforation, bleeding, and the stimulation of [[Reflex syncope|vasovagal reflexes]].<ref>{{Cite book |title=Conscious Sedation: A Handbook for Nurse Practitioners |last=Skelly |first=Meg |last2=Palmer |first2=Diane |publisher=Whurr Publishers |year=2006 |isbn=1861562667 |location=London |pages=69] |url=https://archive.org/details/conscioussedatio0000unse/page/69}}</ref> To avoid sedation risks, care providers conduct a thorough pre-sedation evaluation and this process includes pre-sedation history and physicals with emphasis on the determining characteristics that indicate potential risks to the patient and potential difficult [[airway management]].<ref>{{Cite book |title=Pediatric Sedation Outside of the Operating Room: A Multispecialty International Collaboration |last=Mason |first=Keira |publisher=Springer |year=2011 |isbn=9780387097138 |location=New York |pages=166}}</ref> This process can also reveal if the sedation period needs to be prolonged or additional therapeutic procedures are required.<ref>{{Cite book |title=Pediatric Gastrointestinal Endoscopy: Textbook and Atlas |last=Winter |first=Harland |last2=Murphy |first2=Stephen |last3=Mougenot |first3=Jean Francois |last4=Cadranel |first4=Samy |publisher=BC Decker Inc. |year=2006 |isbn=1550092235 |location=Hamilton, Ontario |pages=59}}</ref>

==Levels of sedation==
Sedation scales are used in [[medicine|medical]] situations in conjunction with a medical history in assessing the applicable degree of sedation in patients in order to avoid under-sedation (the patient risks experiencing pain or distress) and [[over-sedation]] (the patient risks side effects such as suppression of breathing, which might lead to death).{{citation needed|date=February 2022}}

Examples of sedation scales include MSAT (Minnesota Sedation Assessment Tool), UMSS (University of Michigan Sedation Scale), the Ramsay Scale (Ramsay, et al. 1974) and the RASS ([[Richmond Agitation-Sedation Scale]]).{{citation needed|date=February 2022}}

The [[American Society of Anesthesiologists]] defines the continuum of sedation as follows:<ref name=continuum>{{cite web |title=Continuum of Depth of Sedation: Definition of general anesthesia and levels of sedation/analgesia |url=http://www.asahq.org/For-Healthcare-Professionals/~/media/For%20Members/documents/Standards%20Guidelines%20Stmts/Continuum%20of%20Depth%20of%20Sedation.ashx |format=pdf |publisher=[[American Society of Anesthesiologists]] |date=21 October 2009 |access-date=2010-11-29 |archive-date=2010-11-20 |archive-url=https://web.archive.org/web/20101120071827/https://asahq.org/For-Healthcare-Professionals/~/media/For%20Members/documents/Standards%20Guidelines%20Stmts/Continuum%20of%20Depth%20of%20Sedation.ashx |url-status=dead}}</ref>

* Minimal sedation{{snd}} normal response to verbal stimuli.
* Moderate sedation{{snd}} purposeful response to verbal/tactile stimulation. (This is usually referred to as "conscious sedation")
* Deep sedation{{snd}} purposeful response to repeated or painful stimulation.
* General anesthesia{{snd}} unarousable even with painful stimulus.

In the United Kingdom, deep sedation is considered to be a part of the spectrum of [[General anaesthesia|general anesthesia]], as opposed to conscious sedation.

In addition to the aforementioned precautions, patients should be interviewed to determine if they have any other condition that may lead to complications while undergoing treatment. Any head, neck, or spinal cord injuries should be noted as well as any diagnosis of [[osteoporosis]].{{citation needed|date=February 2022}}

==Intravenous sedation==
The most common standard conscious sedation technique for adults is intravenous sedation using [[Midazolam]]. 

Indications:{{citation needed|date=February 2022}}
* Reduced dental anxiety and [[phobia]]
* Traumatic or prolonged dental procedures
* Patients with gag reflex
* Medical conditions potentially aggravated by the stress of dental treatment
* Special care (mild intellectual or physical disability)
* Some disorders involving its spasticity due to its muscle relaxant properties

Contraindications:{{citation needed|date=February 2022}}
* Uncooperative patient
* Psychologically immature individuals
* Patients unable to provide a suitable escort
* Difficult oral surgery or prolonged surgical procedure
* Muscle diseases or diseases which cause muscle wastage
* ASA III or above
* Allergy or hypersensitivity to benzodiazepines
* Pregnancy and breast feeding
* History of psychiatric disorders
* Kidney or liver dysfunction
* Acute pulmonary insufficiency
* Preexisting respiratory conditions as patients are susceptible to respiratory depression
* Alcohol or drug addiction
* Lack of visible superficial veins

== Sedation for pediatric patients ==
{{Cleanup section|reason=Grammar, formatting|date=December 2023}}
Present drugs commonly used to sedate children: [[Methohexital]]; [[Sodium thiopental|Thiopental]]; [[Benzodiazepine]]s; [[Diazepam]]; [[Midazolam]]; [[Ketamine]]; [[Opioid]]s; [[Morphine]]; [[Pethidine|Meperidine]]; [[Fentanyl]].

Whenever it is necessary to sedate a child, one must consider the type of procedure planned (painful or nonpainful), the duration of the procedure (important in choosing the appropriate sedative), the underlying medical condition of the patient (proper fasting, contracted blood volume, interaction with other medications, and intact mechanisms of drug elimination), the need for [[Anxiolytic|anxiolysis]] or [[Narcosis (unconsciousness)|narcosis]], and experience with alternative techniques or routes of administration.

A child undergoing a procedure that is nonpainful (e.g., CT scan or small laceration infiltrated with local anesthetic) does not require a narcotic. Conversely, a child undergoing a painful procedure may require an opioid.<ref>{{Cite journal |last=Coté |first=Charles J. |date=February 1994 |title=Sedation for the Pediatric Patient: A Review |url=https://linkinghub.elsevier.com/retrieve/pii/S0031395516386904 |journal=Pediatric Clinics of North America |language=en |volume=41 |issue=1 |pages=31–58 |doi=10.1016/S0031-3955(16)38690-4|url-access=subscription }}</ref>

==See also==
* [[Palliative sedation]]
* [[Procedural sedation]]
* [[Sedoanalgesia]]
* [[Twilight anesthesia]]

==References==
{{Reflist}}

==External links==
{{Wiktionary pipe|sedate#Verb|sedate}}

{{Authority control}}

[[Category:Anesthesia]]