What is sedation?

Sedation is a relaxing procedure given to patients prior to medical procedures that may cause pain or discomfort. Sedation, which reduces the anxiety in patients before the operation and various medical applications, prevents involuntary reactions by the body, and relieves the pain to be felt during the interventions, is carried out with the help of various drugs. Appropriate ones of these drugs, called sedative drugs, can be given to the patient orally or intravenously. The dose of the drugs given varies according to the patient's age, health status, type and duration of the operation. For this reason, the type and dose of the drug should be determined as a result of the evaluation by experts before the procedure. Sometimes a single dose of sedation is sufficient for such a procedure, while in some cases additional doses may be needed during the procedure. The sedation period can be extended by easily applying additional doses, especially during procedures that take longer than planned. The most severe form of sedation is general anesthesia and patients receiving general anesthesia are completely unconscious. In this case, the patient needs respiratory support and cardiovascular functions may be impaired. The level of consciousness in sedation, in which consciousness is turned off at a lower rate than general anesthesia, varies according to the type of sedation.

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What are the types of sedation?

Sedation is divided into different types according to the pain or discomfort caused by the medical procedure to be performed. The types of sedation determined by the dose of the drug according to the severity of the consciousness-soothing effect of sedation can be listed as follows:

• Minimal (Light) Sedation: Minimal sedation with minimal effect on bodily senses is a type of sedative. The patient feels comfortable and sleepy in light sedation, which is preferred especially in terms of calming anxiety and panic attacks and having a comfortable medical procedure. It can be preferred in cases such as fear of the dentist, fear of needles, or during medical imaging procedures that cause mild discomfort.

• Intermediate Sedation: In moderate sedation, also called conscious sedation or procedural sedation, the patient is in a semi-conscious state. While self-breathing and responsiveness to stimuli continue, the patient's feelings of pain, anxiety and discomfort are significantly reduced.

• Dissociation: Dissociation is referred to as one level of moderate sedation. Medications that prevent sensory stimuli from reaching the higher centers of the brain are used. At this level of sedation, the patient can respond to certain stimuli even if he is detached from his environment.

• Deep Sedation: In deep sedation, which is the sedation phase before general anesthesia, the patient is almost unconscious. The patient given this level of sedation has only purposeful responses to repeated severe and painful stimuli. Cardiovascular functions are generally not impaired, although patients may need assistance with breathing.

• General Anesthesia: In general anesthesia, which is the most severe form of sedation, consciousness is completely closed and no response can be obtained to any stimulus. The patient needs respiratory support and cardiovascular functions may be impaired.

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Who Is Sedation Applied To?

Sedation is a very common sleeping technique used during medical procedures. Before the medical procedure, sedation can be applied to any patient who does not have an allergic reaction to the drugs given during the application. Some of the medical procedures in which sedation is commonly preferred include:

• Routine medical interventions to be applied to patients with mental or psychiatric diseases who are resistant to medical procedures

• Actions to be taken in patients with problems such as anxiety, fear of needles, fear of the dentist and panic attacks

• Tooth extraction and some uncomfortable treatments for oral health

• Dental practices that cause reactions such as nausea and vomiting in children or adults

• Procedures such as endoscopy, bronchoscopy, colonoscopy

• Some computed tomography (CT) or magnetic resonance (MR) applications

• Minor surgical interventions that must be performed on areas such as the feet or skin

• Biopsies

• Circumcision

The risks and side effects of sedation, which is a much safer and easier sleep procedure compared to general anesthesia, are also much less. Some patients may experience fatigue, decreased reflexes, low blood pressure, headache, and short-term memory problems after sedation. Although these are not seen in every patient, they are usually side effects that disappear shortly after the procedure. Not every medical operation, especially the majority of operations, is suitable to be performed with sedation. In such cases, general anesthesia or local anesthesia types are used. Side effects are usually more severe and longer lasting in patients receiving general anesthesia or spinal local anesthesia. Side effects such as nausea, vomiting and headache are significantly more severe in these patients.

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How is sedation applied?

Before an operation or medical intervention to be performed with sedation, a planning is made for the patient evaluated by the anesthesiologist. First of all, the appropriate type of sedation targeted, the type of drug to be used and the dose are determined. In some cases, taking into account the patient's medical history, a chest X-ray to view the lungs and heart, an EKG to check the heart rhythm, and simple blood tests to investigate conditions such as anemia and infection may be requested. The results obtained from these are important for the planning of the medical procedure and sedation application to be performed under sedation. After these evaluations, the monitoring and rescue materials that may be needed during the process are determined and kept ready in the environment where the process will be performed. Before sedation, vascular access is established and analgesic substance is administered. Some of the different types of drugs that can be preferred in sedation are as follows:

• Benzodiazepines (Midazolam, Lorazepam, Diazepam)

• Barbiturates (Methohexital, Thiopental)

• Non-barbiturate tranquilizers (Propofol, Etomidate)

• Opioids (Morphine, Fentanyl, Meperidine)

• Non-opioid analgesics

• Inhalation agents (Nitrous oxide)

• Dexmedetomidine

After deciding on the type of sedation, the appropriate sedation drug and the dose of the drug can be decided. In patients with a history of allergic reactions, the appropriate sedative agents suitable for the medical procedure to be performed may be preferred. When the day of the procedure comes, the sedative agent determined for the desired sedation level is given to the patient and the medical procedure is started after the sedation is achieved. Additional doses may be needed if the patient's consciousness begins to awaken because the desired level of consciousness cannot be reached or the operation takes longer than expected. After this stage, the medical procedure is expected to end. After the procedure is completed, the patient is kept under observation until he reaches his first mental state. Despite the risk of any side effects or allergic reactions, it is beneficial for the patient not to leave the health institution during the process deemed appropriate by the physician.

If you are going to receive sedation or general anesthesia before any medical procedure, you can get information from your doctor about the details of the application. If you need sedation during your planned treatments due to anxiety or concerns, you can request the appropriate treatment with the help of sedation by taking the opinion of your doctor.