May 18, 2022 Author : Anesthesiology Service from Hospital da Luz Setúbal What is a sedation Sedation is a state of relaxation induced by sedative drugs , which can be administered intravenously, orally, or by inhalation . Different levels of sedation are related to the amount of medication administered and can be adjusted to requirements of the medical procedure to be performed. In light sedation the patient does not fall asleep and can speak normally; In moderate sedation , relaxation is more pronounced, it is possible to speak and follow simple instructions, there is drowsiness, and it is possible to fall asleep; Deep sedation is an intermediate state between moderate sedation and general anesthesia. The patient falls asleep and cannot speak. Deep sedation is used in procedures where it is necessary to be asleep or unconscious, but the intensity of pain is not relevant. This is the case, for example, of a colonoscopy or other endoscopic procedures of the digestive or respiratory systems. Sedation can also be used as a complement to local or locoregional anesthesia , to reduce the patient perception of what is going on around them. What is an anesthesia Anesthetizing means administering drugs with the aim of eliminating the perception of pain (analgesia) and/or altering the state of consciousness and/or relaxing and/or controlling reflexes to perform a surgery or other medical procedures. The type of anesthesia to be used depends on multiple factors, for example: The procedure to be carried out; Current health status; Previous illnesses; Patient and responsible medical team options. There are 3 main types of anesthesia : local, regional (or locoregional) and general. Local anesthesia In a local anesthesia, the objective is to eliminate the sensitivity to pain in a limited area of the body , being the local anesthetic drugs injected or applied locally in the area to be anesthetized. Regional or locoregional anesthesia In this type of anesthesia, sensitivity to pain in a region of the body is blocked , and local anesthetic drugs are injected along the nerves responsible for the perception of pain in that region. It can be used in childbirth and in surgeries performed on specific areas of the body , for example an upper limb (arm) or lower limb (leg), in the abdominal and pelvic cavity, chest or face, whenever general anesthesia is not required. Locoregional anesthesia is widely used in orthopedic, gynecological, obstetric, and urological surgical procedures. Locoregional anesthesia can be supplemented with sedation when a patient is not expected to be awake or anxious during the procedure, but a general anesthesia is not required. Among the main types of locoregional techniques we have: Blockade of peripheral nerves , which consists of administering the local anesthetic near the root of the nerve plexus or peripheral nerves in order to block the sensation of pain in the region that is innervated; Neuroaxis anesthesia (epidural or subarachnoid) , which consists of administering the local anesthetic drug in the epidural or subarachnoid space, close to the spinal cord, allowing the blockade of sensation in the chest, abdomen and/or lower limbs. These techniques can also be associated with general anesthesia – combined anesthesia – when a more effective postoperative pain control is required. General anesthesia General anesthesia is used for surgeries or other medical procedures that require: Total unconsciousness; Analgesia (absence of pain); Immobility (muscle relaxation); Inhibition of involuntary nervous reflexes. In general anesthesia, combinations of different types of drugs are used , for example sedatives, hypnotics, inhalational anesthetics, opioid analgesics, muscle relaxants, anti-inflammatory drugs, among others, which have specific functions and a synergistic action. These medicines can be administered intravenously and/or by inhalation throughout the procedure that is performed. During general anesthesia: The patient airway is maintained using specific devices (laryngeal mask, orotracheal or nasotracheal tube) that allow connection to a ventilator; The anesthesiologist remains with the patient , monitoring vital signs and adjusting the amount of anesthetics and duration of anesthesia to the needs and duration of the surgery, being equally prepared to control any complications that occur during the procedure. At the end of the surgery, the anesthesiologist stops the anesthetic administration and wakes up the patient, who should have a smooth and pain-free recovery. A variable period follows in the post-anesthesia care unit, under observation by the nursing team, until recovery from anesthesia is complete. Meet the anesthesiology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
