Conscious sedation in patients undergoing surgical and investigational procedures : A guide to drug choice

• Published in: CNS drugs Vol. 10; no. 5; pp. 329 - 342
• Main Authors: RANDELL, T. T, KYTTÄ, J. V
• Format: Journal Article
• Language: English
• Published: Hong Kong Adis International 01-11-1998; Auckland
• Subjects: Biological and medical sciences; Hypnotics. Sedatives; Medical sciences; Neuropharmacology; Pharmacology. Drug treatments; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Human; Surgery; Radiologic investigation; Anesthesia; Review; Endoscopy; Sedative; Sedation; Route of administration; Child; Biological activity; Biological monitoring
• ISSN: 1172-7047; 1179-1934
• DOI: 10.2165/00023210-199810050-00003

Sedation is often required for a number of procedures to reduce patient anxiety, improve cooperation and ensure immobilisation when necessary. This article provides a concise summary of the recent developments and current techniques of sedation during surgical and investigational procedures. Sedative drugs can be given orally, rectally, sublingually, as an inhalation or an aerosol, or by intramuscular or subcutaneous injection. However, intravenous administration provides the most reliable sedation. In routine practice, intravenous drugs are given in small bolus doses and titrated to effect. However, patient-controlled sedation with either propofol or midazolam has gained popularity in recent years. Target controlled infusion overcomes the problem of varying blood concentrations of the sedative drugs during the procedure, but the technique is currently used mostly in research. The ideal sedative drug provides reliable sedation without untoward adverse effects, and propofol and midazolam meet most of the criteria for an optimal sedative. The recovery from sedation is slightly faster with propofol, whereas midazolam provides better amnesia - the choice between the two drugs remains at the discretion of the physician. Opioids or ketamine can be combined with propofol or benzodiazepines, especially in cases of sedation for painful procedures, such as awake craniotomy, endoscopy of the respiratory or gastrointestinal tract or for investigational radiology. Sedative drugs should always be administered by a trained practitioner, and the monitoring of the patient should include at the very least pulse oximetry and preferably also blood pressure measurement and continuous monitoring of the electrocardiogram. Supplemental oxygen should be routinely delivered during sedation.