What is Procedural Sedation and Analgesia or Conscious Sedation?

Procedural Sedation and Analgesia (PSA) or Conscious Sedation is the safe and effective administration of sedative drugs that relieve anxiety and reduce pain. Sedative drugs are used in very low doses so that the patient is rendered free of any anxiety and discomfort, but can communicate verbally throughout the procedure. The aim of conscious sedation is to make the patient as comfortable as possible, whilst monitoring the patient continuously, so that the painful procedure can be completed in a safe environment. It is done for selective procedures in the dentists' room / procedure room as an alternative to general anaesthesia. This is a very light form of anaesthesia where the patient does not lose consciousness, can still obey commands, but remain calm and sleepy. Certain procedures (dental and medical) can be performed safely and efficiently under conscious sedation outside of the theatre environment. Conscious sedation is a costeffective alternative to general anaesthesia and can be done in most facilities. Sedation is an ideal alternative for the patient who dreads a traumatic theatre experience. Not only is anxiety minimized, patients are back on their feet sooner, without the long recovery period of a general anaesthetic. The side effects experienced with conscious sedation are much less than with a general anaesthetic – very few patients experience any side effect at all. The incidence of post sedation nausea and vomiting is as low as 0.7%. Costs of conscious sedation are significantly lower if compared to the traditional theatre based general anaesthetic option. Patients and medical aids when choosing conscious sedation as an option realize considerable savings. The versatility and safety of sedation coupled with the many benefits to the patient make conscious sedation the perfect choice for many dental and medical procedures. The Continuum of Sedation: Sedation is the production of a depressed state involving a lack of total consciousness with the help of pharmacological agents. In sedation, the protective pharyngeal and laryngeal reflexes are not dulled, so the patient can maintain his or her own airway. In this sedated state, the functional activity or the higher centres of the central nervous system is reduced without distortion of the vital functions. The continuum of sedation is as follows:

• Minimum sedation or anxiolysis: Responds normally to verbal commands.

• Moderate sedation and analgesia or conscious sedation: Responds purposefully to verbal commands or light touch.

• Deep sedation and analgesia: Responds purposefully to repeated or painful stimuli.

• General anaesthesia: No response or reflex withdrawal. It is generally agreed that for sedation to be conscious, it is imperative that:

• The patient should be able to maintain his/her own airway

• The patient remains haemodynamically stable

• The patient’s protective reflexes remain intact

• The patient is able to react to verbal stimulus or light touch.

Conscious sedation is becoming a very popular and safe alternative to general anaesthesia for selected patients and procedures. We are specialized as mobile sedationists.