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Sedation Analgesia

Sedation analgesia”, “twilight sleep”, “conscious sedation”, “sedation”, is terms to describe a semi-conscious state that allows patients to be comfortable during certain surgical or medical procedures. The term “analgesia” refers to the relief of pain that is often included in sedation techniques.

Sedation analgesia can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests. It involves using medications for many types of procedures without using general anesthesia, which causes complete unconsciousness.

Sedation analgesia is usually administrated through an intravenous catheter, or “I.V.”, to relax and minimize any discomfort that the patient might experience. This is often used in combination with an injection of a local anesthetic, or “numbing medicine”, at the site of surgery. Oftentimes, sedation analgesia can have fewer side effects than may occur with general anesthesia. Frequently, there is less nausea from sedation techniques, and patients generally recover faster after the procedures.

Levels of Sedation

Although the effects of sedation are better described in terms of “stages” or being part of a “continuum” sedation is usually divided into three categories:

Minimal Sedation or Anxiolysis

Is a drug-induced state during which the patient respond normally to verbal commands, can understand and answer questions and will be able to follow the physician’s instructions. The patient feel relaxed, and may be awake. Although cognitive functions and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.

Moderate Sedation Analgesia or Conscious Sedation

Is a drug-induced depression of consciousness, during which patient respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Will feel drowsy and may even sleep through much of the procedure, but will be easily awakened when spoken to or touched. May or may not remember being in the procedure room. No interventions are required to maintain a patient airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Deep Sedation Analgesia

Is a drug-induced depression of consciousness during which patient cannot be easily aroused, but respond purposefully following repeated or painful stimulation. Patent will sleep through the procedure with little or no memory of the procedure room. The ability to independently maintain ventilatory function may be impaired; the breathing can slow, and might be sleeping until the medications wear off. Cardiovascular function is usually maintained.

With any of the three levels of sedation, the patient will receive an injection of local anesthetic to numb the surgical site; there will be not discomfort as this medication is injected because of the sedation.

Anesthesia Provider

An Anesthesiologist may administer the sedation.

Anesthesiologists are doctors of medicine who, after graduating from college with strong background in physics, chemistry, biology and mathematics obtain a medical doctorate degree after completing eight years of medical school.

After medical school, today’s anesthesiologists learn the medical specialty of anesthesiology during an additional three years of post-medical school training: an anesthesiology residency program. But, even when the residency training is completed, anesthesiologists continue to spend a great deal of time in special courses and seminars studying new medical advances and anesthetic techniques throughout their careers.

Anesthesiologists need a wide range of knowledge about cardiology, critical care medicine, internal medicine, pharmacology, surgery, medications, how body works, and its responses to the stress of surgery.

Role of an Anesthesiologist

As physicians, anesthesiologists are responsible for administering medications which keep the patient from feeling pain and sensations, ensuring the patient´s comfort, and for managing vital life functions, including breathing, heart rhythm, blood pressure, and brain and kidney functions during the procedure.

However, anesthesiologists´ primary role is to make informed medical judgments to protect and regulate the patient´s critical life functions that are affected by the surgery being performed. Also are the doctors who will immediately diagnose and treat any medical problems that might arise during the procedure or recovery period.

Prior to the procedure, anesthesiologists evaluate the patient´s medical condition and formulate an anesthetic plan for each individual patient taking into consideration patient´s physical status. Therefore, it is important the anesthesiologists knows exactly what medical problems have and any medications the patient have been taking recently and past anesthetic experiences.

During procedure, anesthesiologists monitor the body´s functions, and interpret it in order to appropriately diagnose, regulate and treat the body´s organ systems while a personalized, very delicate balance of anesthetic medications is administered.

At the conclusion of procedure, anesthesiologists reverse the effects of the anesthetic medications, and return the patient to consciousness once again. They maintain the patient in a comfortable state during recovery.  Anesthesiologists also are involved in the practice of chronic pain management.

Dr. Josef Cordero &  Dr. Telma Rubinstein

Sedation Analgesia
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