Conscious Sedation

A Brief Overview

Janette LaFroscia, RCES, RCIS, RCS

 What is Conscious
Sedation?

A type of sedation that induces an altered

state of consciousness that minimizes pain and
discomfort through the use of pain relievers
and sedatives.

American Association of Nurse

Anesthetists
Why use Conscious
Sedation?

Safeand effective for patients who need minor

surgery or diagnostic/interventional procedures

Allows for quick recovery

Patients Experience

NPO after midnight on day before procedure

Ableto speak and respond appropriately

throughout the procedure

Brief period of amnesia may result

 Sedation Classes

American Society of Anesthesiologists

(ASA) is responsible for developing practice
guidelines for procedural sedation

Four sedation depths classified

 Sedation Classes

Minimal Sedation
Response to verbal stimulation is normal.

Cognitive function and coordination may be

impaired.

Ventilatory and cardiovascular functions are

unaffected.
 Sedation Classes

Moderate Sedation (Conscious Sedation)

Patient responds purposefully to verbal
commands.

Airway is patent, and spontaneous ventilation

is adequate.

Cardiovascular function is usually unaffected.

 Sedation Classes

Deep Sedation
Patient is not easily aroused but responds
purposefully following repeated or painful
stimulation.
Independent maintenance of ventilatory
function may be impaired.
Patient may require assistance in maintaining a
patent airway.
 Sedation Classes

Deep Sedation continued

Spontaneous ventilation may be inadequate.

Cardiovascular function is usually maintained.

 Sedation Classes

General Anesthesia
Patient is not able to be aroused, even by
painful stimulation.

Patient'sability to maintain ventilatory

function independently is impaired.

Cardiovascular function may be impaired.

 Sedation Classes

General Anesthesia continued

Patient requires assistance to maintain patent
airway, and positive pressure ventilation may
be required because of depressed spontaneous
ventilation or drug-induced depression of
neuromuscular function.
Who can administer?

Anesthesiologists
Other MDs
CRNAs
Dentists/Oral Surgeons
RNs
Other credentialed AHPs
Typical Equipment
Needed

Supplemental oxygen
Suction
Airway management supplies
Resuscitation medications and equipment
IV access
Reversal agents
 Medications

Typically,
sedatives are used in conjunction
with analgesics (pain relievers) for conscious
sedation

This combination can have a synergistic

effect, a result greater than the sum of the
individual medications.

Dosage is titrated for desired effect in each

patient
 Medications

Sedatives (initial dosage in parentheses):

Valium (Benzodiazepine)
Given PO (5-10 mg) and/or IV (5 mg)

Versed (Benzodiazepine)
Given IV (1-2 mg)
 Medications

Analgesics (initial dosage in parentheses):

Fentanyl (Narcotic)
Given IV (12.5 25 mcg)

Morphine (Narcotic)- less common

Given IV (2 4 mg)
 Medications

Hypnotics, typically given only by

anesthesiologist/CRNA:

Propofol (hypnotic)
Given IV using weight-based dosing

Etomidate (hypnotic)
Given IV using weight-based dosing
Usually given in combination with sedatives
 Medications

CAUTION!

Dosages need to be adjusted for elderly

patients and pediatric patients.

Regular dosing may cause severe side

effects and complications.
 During Procedure

Patient must be monitored closely!

EKG, Heart rate, BP, Oxygen saturation,
Airway, Respiratory rate, Response to
stimuli, Appearance of patient

Vital signs taken every 5 minutes at minimum

 Side Effects

Patientsmay experience any or all of the

following:

Headache
Nausea & Vomiting
Hangover
 Complications

Respiratory depression

Respiratory arrest

Hypotension

Reversal
 Reversal/Rescue

Rescue of a patient from a deeper level of

sedation than intended; correction of adverse
physiologic consequences of the deeper-than
intended level of sedation (such as
hypoventilation, hypoxia and hypotension) and
returns the patient to the originally intended
level of sedation. -ASA
 Reversal Agents

Medications are available to counteract the

effects of conscious sedation drugs:

Naloxone- used for narcotic reversal

Flumazenil- used for benzodiazepine
reversal

Carefulmonitoring of patient is required-

duration of action is less than narcotics and
benzos
 Post Procedure

Patientwill be closely monitored 30 minutes to

2 hours after procedure.
Depending on type of procedure and
amount of each individual patients recovery
time, discharge can be as soon as one to two
hours

Patient
should not drive, operate heavy
machinery, or make any legal decisions for 24
hours.
 Summary

Conscious sedation is quick-acting and

effective

Recovery times are short

Complications are rare

Patientsshould be monitored closely by a

professional trained in life support
techniques
 References

www.aana.com
www.nlm.nih.gov
www.asahq.org
emedicine.medscape.com
www.pdrhealth.com