Sedation involves administering a sedative and tranquilizing drug to the patient. In this way, anxiety as well as stress reactions can be controlled. Sedation is most commonly used as part of anesthesiologic premedication, in which case it smoothly transitions to general anesthesia.
What is sedation?
During sedation, the physician administers a sedative to the patient. This is a sedative drug that downregulates the functions of the central nervous system. In sedation, the physician administers a sedative to the patient. This is a sedative drug that reduces the functions of the central nervous system. Treatment with a tranquilizer is to be distinguished from this. Such tranquilizers are anxiety-relieving and relaxing psychotropic drugs of the same drug group. In the broadest sense, they too can theoretically be used for sedation. As a rule, however, they are administered in low doses and are used in particular for relaxation in conflict situations and muscle spasms. Anesthesia should not be confused with sedation either. Anesthetized patients cannot be awakened for the duration of the anesthesia. Sedated patients, on the other hand, are generally awake. In most cases, however, there is a smooth transition between sedation and anesthesia. That is, the patient is first sedated and then transferred from sedation to anesthesia. Often, the physician gives an analgesic in addition to the sedative. In such a case, it is also called analgosedation. In addition to artificial substances, some purely herbal substances are also available for sedation. Herbal forms of sedation make use of non-prescription substances and can even be performed on one’s own.
Function, effect, and goals
Sedations are intended to calm the patient. Restlessness is one of the most common accompanying symptoms of many mental, as well as physical, illnesses. The sedative relieves such restlessness and may have a sleep-promoting effect. For example, suicidal or severely psychotic patients receive sedation as standard. In the case of psychosis, sedation can bring about a distancing from the respective fears. Sedatives given in large quantities cause the patient to lose conscious awareness almost entirely. This also eliminates the patient’s fears. In this context, sedatives are an important aid before operations. In this context, doctors also refer to sedation as anesthesiological premedication. However, they are also given before therapeutic and diagnostic procedures. The stress level before these procedures would often be too high without sedation. Lightly sedated patients remain responsive but are still relieved of stress levels. Sedatives may also be given for severe pain in some circumstances. Sedation plays a special role in general critical care. For example, if a patient is to be ventilated, this would hardly be possible without deep sedation. Ventilation measures are usually not tolerated by a non-sedated organism. Sedatives differ in their dosage and drug type with the intended use. The dosage form also depends on the intended use and especially on the type of sedative. However, most sedatives are administered orally or intravenously. In addition to benzodiazepines such as diazepam, antidepressants such as trazodone, narcotics such as propofol, and barbiturates such as phenobarbital are available for sedation. Neuroleptics such as promethazine and opioids such as morphine may also be considered. In general, alpha-2-adrenoceptor agonists such as clonidine are now mainly used for sedation. In individual cases, however, H1 antihistamines such as hydroxyzine or purely herbal sedatives such as valerian are also used. The deeper the sedation, the longer it lasts. To achieve deep sedation, a correspondingly high dose is needed. To accurately plan dose, depth, and sedation duration in the context of a particular sedative, the physician usually uses the Richmond Agitation Sedation Scale or the Ramsey Score. The DGAI guidelines can also provide a framework for sedation interventions. In particular, the S3 guideline is currently used to coordinate measures. Unlike the Ramsey Score, this guideline provides near 100% reliability.
Risks, side effects, and hazards
Overdoses of sedatives can cause a complete loss of consciousness.This phenomenon may be intentional in some circumstances. In other cases, this transition to general anesthesia is unintentional and poses dangers for the unprepared physician. To avoid this, the physician must take appropriate protective measures in advance. Deep sedation thus usually takes place under intensive medical supervision. This is primarily intended to minimize the risk that the sedation will switch off the patient’s protective reflexes or provoke respiratory and circulatory depression. One problem with the prolonged administration of sedatives is tolerance. Thus, after a certain time, immunity occurs and the physician must increase the dose of the drug to maintain the desired depth of sedation. In continuous use, sedatives also carry a high risk of abuse and addiction. An exception in this case are neuroleptics, which are not associated with addiction potential. With deep sedation, there is a risk of circulatory collapse and respiratory arrest due to complete loss of consciousness. For this reason, particularly deep sedation usually requires additional ventilation and maintenance of the cardiovascular system with catecholamines. As a rule, the patient must give written consent to a planned sedation. Exceptions in this context are suicidal and psychotic patients. In individual cases, sedatives do not produce the desired effect. For example, the administration of the aids sometimes causes the patient to become even more agitated. In extreme cases, the sedated person is thus no longer able to be guided and controlled.
