Is Procedural Sedation the Same as Moderate Sedation?

Procedural sedation is usually minimal or moderate sedation; the lower tier of four specific sedation levels recognized by anesthesiologists and other clinicians.

Procedural sedation induces relaxation and a depressed level of consciousness in patients who undergo certain noninvasive or minimally invasive procedures. Procedural sedation involves the administration of sedatives and pain relievers (analgesics) before minor procedures.

Procedural sedation makes it easier for patients to tolerate unpleasant medical procedures while being partially conscious, able to breathe on their own, and respond to verbal and physical stimulation.

Procedural sedation and analgesia are used to induce minimal or moderate sedation. There are four levels of sedation and following are the typical characteristics of each:

Minimal sedation (anxiolysis)

• Normal verbal response
• Cognitive function and coordination may be affected
• No effects on breathing and cardiovascular functions

Moderate sedation/analgesia (earlier known as conscious sedation)

• Moderately depressed level of consciousness
• Response to verbal commands and physical stimulation
• Breathing and cardiovascular functions are usually not impaired

Deep sedation/analgesia

• Deep depression of consciousness
• Purposeful response only to repeated or painful stimuli
• Breathing may be impaired and the patient may require assistance for breathing and keeping the airway clear
• Cardiovascular function is usually not affected

General anesthesia

• Complete loss of consciousness
• No response to even painful stimulation
• The patient will require mechanical ventilation and assistance in maintaining a clear airway
• Cardiovascular functions may be impaired

Many noninvasive and minimally invasive medical procedures are performed in the physician’s office, and do not require general anesthesia. These minor procedures, however, can cause discomfort, anxiety and pain to the patient.

Procedural sedation relaxes the patient and provides pain reduction to tolerate minor medical procedures. Moderate sedation eliminates the need for general anesthesia and its associated risks. Recovery is faster and the effects of some of the sedative agents can also be reversed to minimize sedation effects.

Conscious sedation may be used in many procedures including:

• Dental surgery
• Tissue biopsy
• Labor
• Adult colonoscopy
• Endoscopy
• Treatment of minor bone fractures
• Lumbar puncture

Preparation

Prior to procedural sedation, the patient may be required to fast for a few hours. The doctor is prepared with the equipment to provide breathing assistance, cardiovascular support and reversal agents, if the sedation gets deeper than intended for the procedure.

The steps taken before administration of procedural sedation include the following:

• Informed consent from the patient after explaining:
  • About the procedure
  • Reason for the procedure
  • Benefits from the procedure
  • Risks and how they can be averted
  • Alternatives to the procedure
• Physical examination of the patient to test
  • Heart and lung functions
  • Blood pressure and other vital parameters
  • Airway assessment and presence of any loose teeth
• Obtaining information on the patient’s history regarding
  • Abnormality with any of the major organ systems
  • Drug allergies
  • Use of current medications or herbal products
  • Tobacco, alcohol or substance abuse
  • Prior adverse events with sedation or general anesthesia

Procedure

The sedative agent and analgesia are usually administered intravenously in adults. For children, sedation may be performed using one of the following methods:

• Oral
• Intranasal
• Intramuscular
• Intravenous
• Rectal

Monitoring

During and after procedural sedation, until the patient is stable, the physician continuously monitors their vital signs including:

• Blood pressure and heart rate
• Oxygen saturation and airway patency
• Response to verbal commands and physical stimulation
• High-risk patients may undergo ECG monitoring
• Carbon dioxide concentration may also be monitored (capnography)

Anesthesia reversal

Reversal agents may be used after the completion of the procedure, to counter the effects of certain anesthetics if required.