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What is Deep Sedation/Analgesia?
Deep
sedation is an even higher level of sedation where the
patient is clearly sedated and may only respond minimally to
very significant stimuli (such as high levels of pain, etc.)
or may not even respond at all in some cases.
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Effects of Deep Sedation/Analgesia
There are two primary objectives in the process of
sedation. First, sedation allows the patients to tolerate
unpleasant diagnostic or surgical procedures and to relieve
anxiety and discomfort. Second, sedation helps uncooperative
patients expedite and simplify special procedures that need
very little or no movement. Sedation is also often needed to
lessen the fear associated with operative procedures.
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Candidates for Deep
Sedation/Analgesia
This
procedure is recommended for patients who need to undergo
diagnostic or surgical procedures that require deep
sedation. The doses can always be adjusted as the situation
demands. Another candidate for this is an agitated or confused
patient who does not respond to reassurance, especially if
the patient has cardiopulmonary compromise that is affected
by physiologic stress.
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Your
Consultation
Before
the administration of medications, it is essential for
physicians to find out the level of sedation required for a
given procedure and to provide the appropriate dose of the
pharmacologic agent or agents selected. This will help
determine the equipment that is needed prior to starting the
procedure. Some considerations before and during sedation
include periprocedural patient assessment, periprocedural
fasting and monitoring.
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The Deep Sedation/Analgesia
Procedure
The patient should have a qualified person
present who should monitor the patient’s physiologic
parameters when the sedatives are being administered. But
before sedation should even be initiated, sufficient
interviews and explanations should be done. The
contra-indications to sedation should be well thought-out in
every case. Also, the monitors should be routinely in place
during the application of sedation.
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Recovery
After the procedure, the patient will be placed in a
recovery room where the assessment of residual drug effects
will take place. The recovery room monitoring will primarily
focus on the patient’s heart stability, respiratory adequacy
and return to previous brain functioning.
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Risks
With deep sedation, the patient is not easily aroused but
responds purposefully to painful stimulation. Other risks
may include the patient’s inability to maintain a patent
airway and the inadequacy of spontaneous ventilation.
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Frequently Asked
Questions
Q:
What happens during Deep Sedation/Analgesia?
A:
Deep Sedation/Analgesia is a
drug-induced depression of consciousness where patients
cannot be easily aroused but respond purposefully to painful
stimulation. During the procedure, the ability to maintain
ventilatory function may be impaired. It is also possible
that patients may require assistance in maintaining a patent
airway, and spontaneous ventilation may not be adequate.
Cardiovascular function though, is usually maintained.
Q: Who
should administer sedation?
A:
Administering sedation is a learned skill, and just like
other skills that are practiced in the delivery of
healthcare, individuals handling sedation need to be
trained. This training teaches skills that are necessary and
gives credentials to the healthcare provider in order to
make sure that they are qualified to provide sedation in a
safe way.
Q:
What is unconscious sedation?
A:
Unconscious sedation is a controlled state of anesthesia. It
is characterized by partial or complete loss of protective
nerve reflexes, which includes the ability to independently
breathe and respond to commands. With unconscious sedation,
the patient is unable to cooperate, has fluctuating vital
signs, prolonged recovery room convalescence, and a higher
risk of anesthetic complications.
Q:
What are some clinically relevant contraindications to
sedation?
A:
The
relevant contraindications are the following:
-
conditions where there is an increased risk of pulmonary
aspiration
-
the possibility of airway obstruction or respiratory
irregularities
-
raised intracranial pressure, or other conditions where
increased PaCO2 could be harmful
-
conditions wherein the respiratory center is
desensitized to carbon dioxide
-
renal or hepatic dysfunction that may alter drug
kinetics
-
unpredictable drug effect, as sedatives may heighten
restlessness
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