Sedation

Sedation is a pharmacologic state of reduced consciousness and diminished responsiveness used to facilitate procedures, relieve anxiety, and control pain. It ranges from minimal sedation to deep sedation and is distinct from general anesthesia, though boundaries can blur with deeper levels. Sedation decisions depend on the procedure, patient health, and risk factors, and require informed consent and appropriate monitoring.

Common sedatives include benzodiazepines (eg, midazolam), non-benzodiazepine agents such as propofol, dexmedetomidine, ketamine, and etomidate, and analgesics like fentanyl when needed. Routes include oral, intramuscular, intravenous, or inhaled delivery, with onset and duration varying by drug, dose, and patient characteristics. The choice of agent aims to achieve the desired level while preserving safety.

Levels of sedation are minimal, moderate, or deep. Minimal sedation preserves protective reflexes; moderate sedation allows verbal response; deep sedation significantly depresses consciousness and may require airway support. These classifications guide monitoring intensity and personnel requirements during care.

Safety and monitoring are critical. Risks include respiratory depression, hypoventilation, airway obstruction, hypotension, and oversedation. A pre-sedation assessment, careful dosing, continuous monitoring of airway, breathing, circulation, and level of consciousness, and readiness to manage complications are essential. Recovery observation and discharge criteria help ensure safe return to baseline function.

Special considerations apply to children, older adults, pregnant patients, and those with comorbidities. Ethical practice emphasizes informed consent, appropriate staffing, and adherence to professional guidelines. Alternatives to pharmacologic sedation include nonpharmacologic anxiety reduction and minimizing sedative exposure whenever feasible.