Sedation

The main objectives of sedation are:

• to reduce anxiety, awareness and psychological sequelae associated with diagnostic or therapeutic procedures;

• to enhance patient cooperation.

Sedation has important differences from anaesthesia. It is possible to arouse a patient by simple commands and sedation does not abolish response to pain.

Drugs can be administered intermittently, by continuous infusion, or by patient-controlled sedation. The most commonly used drugs are propofol, midazolam, fentanyl and alfentanil, nitrous oxide, isoflurane and occasionally keta-mine. Many anaesthetists combine an hypnotic agent, to provide sedation and amnesia, with a short-acting opioid to provide analgesia and drowsiness. It is important to realise the differences between analgesia and sedation as the drugs which supplement one can potentially worsen the other. Patients undergoing sedation should normally receive supplemental oxygen.

Individual response varies enormously and sedation may end in excessive central nervous system and cardiorespira-tory depression, with loss of airway, apnoea, hypoxaemia and hypotension. Equipment and monitoring should be comparable to that ordinarily required for a general anaesthetic on the same patient.

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