Anesthesia

Conscious Sedation - for which procedures?

01/08/2003

Question:

I have had several cystoscopies into the bladder and up into the kidneys for kidney stones and on one occasion had a stuck stone scraped off the ureter wall and a prostate biopsy which made the procedure last awhile; therefore, the question:
In all cases, I was given conscious sedation with Versed and perhaps other agents. These agents seemed to be able to "put one to sleep" (or in a twilight) almost immediately and allowed the anethesiologist to awaken me almost immediately. For a medical procedure, this method seemed excellent since there was no pain or nausea and everything seemed to be short acting -- what a wonderful experience. Now, for what types of procedures and to what *extremes* (more difficult procedures) can this method be used?
Thanks!

Answer:

Thanks for your question! I’ll start by giving you the “official” definitions of four different levels of sedation. These definitions were created by the American Society of Anesthesiologists, and were recently adopted by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), the most important agency that accredits hospitals in the United States.

1. Minimal sedation (anxiolysis) is a drug-induced state during which patients respond normally to verbal commands.

2. Moderate sedation/analgesia (conscious sedation) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.

3. Deep sedation/analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation.

4. Anesthesia consists of general anesthesia and spinal or major regional anesthesia. It does not include local anesthesia. General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation.

The surgical procedures you describe (cystoscopy, removal of stones, prostate biopsy), if performed in an operating room, would usually require deep sedation or general anesthesia (levels three and four). The drugs that are used to provide minimal or moderate sedation are also used in many cases as part of the regimen for deep sedation and general anesthesia. Versed (midazolam) is one of the commonly used drugs. Propofol is another very useful agent. Higher doses of these drugs are obviously used to provide deeper levels of sedation and anesthesia. Modern anesthetic agents, given in a carefully measured fashion, with attentive monitoring, can provide patients with a relatively comfortable experience, with rapid onset, rapid awakening and a minimum of side-effects. This applies to all levels of sedation and anesthesia. The judgment about the most appropriate form of sedation or anesthesia for a particular surgical procedure is one best made by a qualified anesthesiologist, taking into account the needs of the surgeon and the preferences of the patient.

For more information:

Go to the Anesthesia health topic, where you can:

Read articles on this topic
Browse the previously asked questions
Ask your own question.

Response by:

Gareth S Kantor, MD
Assistant Professor
Department of Anesthesiology
University Hospitals
School of Medicine
Case Western Reserve University