What is procedural sedation or "twilight anesthesia"?

You may have undergone procedural sedation without realizing it qualified as anesthesia. If you have had wisdom teeth taken out, for example, you have more than likely had procedural sedation. This anesthesia is used for a short, relatively minor medical procedure and is known as conscious sedation or twilight anesthesia. Beyond dental work, procedural sedation is used for setting broken bones, minor cosmetic surgeries and LASIK.

Under procedural sedation, you remain awake and can answer to questions and respond to instructions. That does not mean you know what is going on – you shall be sleepy and relaxed. Typically, you would not remember the procedure or the short time following it. Some drugs used in procedural sedation can make you feel giddy or euphoric.

General anesthesia and procedural sedation have a lot in common. That is because the same drugs or types of drugs that are used in general anesthesia also are administered in procedural sedation; they are just given in much smaller amounts. This usually means sedatives such as nitrous oxide or ketamine, which depress the central nervous system. Sometimes dissociatives, which keep nerve sensations from reaching the brain, are used instead, including diazepam (commonly known as Valium) or midazolam.

High doses of these drugs induce sleep and paralysis and affect the cardiovascular system. Lower doses, however, calm the patient and reduce anxiety. In procedural sedation, one of these drugs is used in combination with an analgesic, like fentanyl for pain relief. Anesthetics such as these may be inhaled, injected, given orally or used in any combination of the three methods. Nitrous oxide, for example, and other sedative gases are inhaled. Ketamine and Valium are injected into an IV line.

The length of the procedural sedation lasts depends on the drugs -- it may be as few as five minutes or as long as an hour. Recovery is speedy so you would not usually have the side effects associated with general anesthesia, which can include vomiting, nausea or dizziness (but these can still occur). Patients under conscious sedation have to be monitored carefully to ensure that they don't slip into deeper sedation.

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