Conscious sedation has its risks

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Planning to get a procedure done? Right now, you might be considering conscious sedation.

This light form of anaesthesia, where you still have control over your breathing and swallowing, and are able to communicate, is gaining popularity worldwide.

But what many people don't know is that conscious sedation can be dangerous – especially if it isn't performed by a trained anaesthesiologist.

Where conscious sedation fits in
Anaesthesia has many different applications. In order to understand where conscious sedation fits in, one needs to see it within the broader context of the different types of anaesthesia.

Firstly, the difference between anaesthesia and sedation needs to be explained.

General anaesthesia is an altered state of consciousness, where painful sensation is reduced or abolished, explains Cape Town anaesthesiologist Dr Danté Wessels. To accomplish this deep state of sleep, potent mind-altering drugs are used. As these drugs affect breathing and the upper airway reflexes, it is necessary to monitor the function of the different organ systems throughout the procedure.

Sedation, on the other hand, employs drugs that have a calming effect. The drugs are used in a much lower concentration, as the anaesthesiologist attempts to reduce anxiety and stress input to the brain. Normal breathing, swallowing and coughing is maintained.

For certain operations a deep state of unconsciousness isn't necessary. Here, local anaesthesia has proved to be a useful supplement, especially in terms of cosmetic and dental procedures. With local anaesthesia, sensation is merely dulled in a particular area of the body.

Over the years, however, it has become clear that this form of anaesthesia isn't always ideal either. While it certainly helps in terms of the pain element, local anaesthesia falls short in terms of reducing anxiety in patients.

A few years ago, dentists started to recognise the need for an anaesthetic method that targets both pain and anxiety without being as intense as general anaesthesia. In terms of cost efficiency and comfort, there was also a need for a method that could be applied in the dentist's chair, and not only in a hospital operating theatre.

And so, conscious sedation was born. With this anaesthetic method, all the above criteria were met. Added benefits included a shorter recovery period for patients, less anxiety, and fewer side effects such as nausea and vomiting. It also proved to be a lot cheaper than general anaesthesia.

Anaesthesiologists only
Today, conscious sedation is applied in a variety of different settings and for many different procedures.

There's no doubt that conscious sedation has many advantages. As a result, many medical practitioners – who didn't train as anaesthesiologists – are jumping on the bandwagon. During the past few years, it has proved to be a lucrative source of income for general practitioners.

Wessels believes that conscious sedation should be done exclusively by anaesthesiologists – in other words, specialists who are trained to handle anaesthesia-related complications.

He explains that the same drugs that are used for general anaesthesia are used for conscious sedation – just at lower doses and in a more controlled manner. This, Wessels says, makes conscious sedation even more complex than general anaesthesia.

"Conscious sedation is an art," he says. "The dosages differ from individual to individual and the patient's reaction to the medication can't be predicted. When performing conscious sedation, you're also not in your comfort zone as an anaesthesiologist – the patient is actually awake."

Despite the convenience, it could be risky when a GP or dentist performs conscious sedation in his/her consulting room. If the consulting room isn't in close proximity to a hospital, emergency equipment and the expertise of a trained anaesthesiologist probably isn't available. Should complications occur, it could be fatal.

Wessels notes, however, that complications are generally rare.

What to do
When you're considering having a procedure done under conscious sedation, it's important to insist on involving an anaesthesiologist.

Note, however, that the anaesthesiologist also needs to have training and experience in conscious sedation. It's your right to ask for credentials.

Also check that the procedure will be done in a facility where doctors have access to emergency equipment. Conscious sedation can be a wonderfully convenient option, but its dangers shouldn't be underestimated. – (Carine van Rooyen, November 2008)

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