Procedure of a twilight sleep anaesthesia
Before any medical intervention, the patient must be informed. Normally this information takes place at a separate appointment. Before the procedure, the patient is given a venous access into the back of the hand or the crook of the arm.
In children this is sometimes avoided and the benzodiazepine is given directly through the nasal mucosa. This means that the drug is either injected directly into the bloodstream or atomised in the nose. The effects of commonly used benzodiazepines, such as midazolam, start within minutes.
The patient becomes tired and his ability to concentrate decreases. Some people also fall asleep directly. Depending on the drug used, a follow-up injection may be necessary for longer procedures.
After the effect of the medication is complete, local anaesthesia is applied if necessary. The patient will hardly notice the intervention itself and will hardly remember it after the intervention. After the procedure, the patient can usually sleep for another hour and can then be picked up by a relative. During the first 24 hours after the twilight sleep anaesthesia, no motor vehicles may be driven.
Advantages of a twilight sleep anaesthesia
A twilight sleep anaesthesia means a significant reduction of anxiety and stress for the affected person compared to a local anaesthetic only. This also makes itself felt physically. The heart rate and blood pressure are lower and the oxygen consumption also decreases.
In addition, if the experience is positive, there is less chance that the person concerned will refuse a necessary examination next time. Especially in children, fewer post-traumatic stress disorders are observed after twilight sleep anaesthesia. Compared to general anaesthesia, twilight sleep anaesthesia also has several advantages.
Since the patient breathes independently, no ventilator is required. Artificial respiration has some side effects, such as vocal cord irritation, which can be avoided. Although twilight sleep anaesthesia also has central attenuating effects on the circulation, it does not have as strong an effect as general anaesthesia, which means that circulatory stabilising drugs have to be used less frequently. Less control of vital functions is required during the procedure and the affected person can go home directly after the procedure. The only limitation remains the inability to drive for 24 hours.
Risks and side effects
Sedating drugs calm the affected person both physically and psychologically. This effect can go beyond the actually defined goal. In medical interventions this can mean the difference between a twilight sleep and anaesthesia.
Sedatives also have an effect on blood pressure, heart rate and the drive to breathe. If the dosage is too high, breathing can stop and the circulation collapses, as both areas are downregulated. In this case, the patient must be ventilated and the circulation must be stabilized with medication.
In some patients, especially in children, a paradoxical reaction to the sedative is possible. The patients become restless and the intervention must be interrupted. In case of strong reactions, an antidote must be given. The benzodiazepines used also cause amnesia, so people may feel they have a blind spot in their memory. In older people, frequent use increases the likelihood of developing dementia.
