Conscious sedation with analgesia and procedural sedation

Procedural sedation is a technique in which a drug with a relaxing function is administered (sedatives). Do not confuse sedation with anesthesia, which is the procedure of blocking sensitivity. Anesthesia is used in order to avoid painful sensitivity. That is, it eliminates the pain (analgesia).

What is conscious sedation with analgesia?

Conscious sedation with analgesia is a Combined technique where relaxation and pain elimination techniques are used at the same time. In this way the patient is awake (he may be slightly drowsy, but he is conscious at all times), but he does not feel any pain while undergoing medical intervention.

This technique it is used very frequently in dental surgical procedures. Being short-term interventions, it is possible to avoid pain without the possible complications of a general anesthetic.

It is a simple process in which drugs are administered, usually in an intramuscular injection although the intravenous route can also be used if the procedure is longer.

Any of these routes acts quickly so that in about half an hour the effect will be total and the patient will be in optimal conditions to carry out the surgery.

The respiratory rate will decrease slightly and also the pulse and blood pressure. These are clinical signs of relaxation. Oxygen can be used in a mask so that pulmonary oxygenation costs less effort.

At the end of the intervention it is possible that the patient is sleepy or has a very vague memory of what has happened. If you fall asleep during the process, absolutely nothing happens given that it is a normal physiological response of the organism to sedatives.

What is conscious sedation with analgesia used for?

As we mentioned earlier, It is used a lot in dentistry. Thanks to the safety of this type of technique and the short duration of the process is an ideal technique. But that's not all, it can also be used in minor surgery procedures such as the following:

  • Minor surgeries in dermatology: such as the removal of a nevus or mole, a wart, etc.
  • Minor finger repair surgery: repair of minimal fractures that require very simple plastic surgery techniques. For example, crossed fingers where the nail has detached, etc.

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What is procedural sedation?

Procedural sedation is a conscious sedation technique with analgesia during the diagnostic processes.

We have previously emphasized that the best advantage of conscious sedation with analgesia is the speed at which to achieve the desired effect and the safety it provides. In the diagnostic processes, it is, without a doubt, the best technique and the one that is used the most since its drawbacks are practically non-existent.

Some diagnostic processes are especially annoying for the patient, as in the case of endoscopies or bronchoscopies, where the introduction of the optical tube generates anxiety to the patient.

Thanks to procedural sedation, the patient does not suffer and the results are more reliable by avoiding reflexes that can hinder the exploration or alter the results. For example, reflexes of vomit, spasm, etc.

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Drugs most used in procedural sedation

Mainly propofol is used at an initial concentration between 0.5 and 1 mg / kg and a maintenance dose of 05 mg / kg. Propofol has a very short half-life because it is rapidly eliminated from the body and gives great security in muscle relaxation. However, it has no analgesic effect and therefore requires combining it with another medication.

Another very popular drug is intravenous ketamine. With great results in children patients at doses as low as 1.5 mg / kg in long procedures.

It allows the patient to maintain respiratory reflexes, but it can worsen the tachycardia and cause hypertension. So you have to monitor the patient or, if possible, replace it with another sedative.

Dexmedetomidine, on the other hand, causes bradycardia and hypotension. But it has the advantage of allowing stimulation even though the patient is sedated. Which is very useful in neurophysiology.

Almost all have as common side effects the anterograde amnesia and vomiting just after the end of the pharmacological effect. Otherwise there are no contraindications, although in babies and in the elderly the doses change.