Moderate sedation is not only administered during surgeries. It is a pretty standard procedure even for various routine health checkups. Let’s discuss the 6 most frequent use cases.

Sedation During Health Screening: 6 Use Cases

Sedation in healthcare refers to the depression of awareness, whereby a patient’s response to external stimuli becomes limited. Sedation can be minimal, moderate, and deep. Minimal sedation is commonly given only to relieve anxiety with little effect on patient awareness, while deep sedation depresses awareness to the point where the patient only responds to painful stimuli. Moderate sedation leaves the patient relaxed enough not to disrupt the medical procedure yet conscious enough to respond to verbal instructions or repeated tactile stimulation.

As you might imagine, a botched sedation procedure can significantly affect a patient’s life. Therefore, structured and complete safe sedation training is an important part of every sedation practitioner’s career path and an important tool in every medical practitioner’s basic life support skill set. To illustrate just how important and commonplace sedation is in routine healthcare procedures, let’s explore six areas of medicine that use sedation and why exactly it is needed.

1. Colonoscopy

A colonoscopy is a procedure in which an endoscopist inserts a long flexible tube wired with a camera into a patient’s large bowel. This is done to check for abnormalities i.e. inflammation, infection, etc, and confirm a diagnosis. The procedure is relatively painless, but many people are embarrassed by the nature of the procedure because it involves navigating a tiny device through the anus and into the lining of the large intestines.

To take patients’ minds off whatever discomforts they have and keep them relaxed, the colonoscopist or a qualified sedation practitioner will administer a sedative intravenously. These sedatives may include fast-acting opioids like fentanyl or benzodiazepines like midazolam.

Before, during, and after the procedure, the colonoscopist will monitor the patient’s vital signs at regular intervals to be sure the medication was administered safely. Then once the colonoscopy is complete, patients are moved to a recovery area and monitored again until the effects of the medications wear off.

2. Endoscopy

Adequate sedation is a key part of endoscopic procedures, which involve passing a camera into the body to assess the health of its internal parts. Due to the discomfort patients develop when thinking about the procedure beforehand and during the procedure itself, most endoscopies are performed with the patient under moderate sedation. Before the procedure, the endoscopist will conduct an evaluation to assess the patient’s risk and determine preexisting medical conditions.

Then, the patient is administered a sedative intravenously or in pill form. The sedatives of choice in this case are either benzodiazepines midazolam and diazepam or opiates such as fentanyl or meperidine.

After the check-up, patients are monitored for adverse effects. Once vital signs stabilize and the patient reaches an appropriate level of consciousness, the patient may then be discharged from the endoscopy unit.

3. MRI/CT

Magnetic resonance imaging (MRI) is a useful tool for diagnostic imaging, but MRI examinations can be difficult to perform on those with claustrophobia. This happens because the patient has to be enclosed in a noisy cylindrical space for up to 30 minutes or longer. For example, in breast cancer examinations, the patient has to lay still in a prone position to ease the identification of a lesion by spreading the breast tissue appropriately. A similar case is with computerized tomography (CT) scans, as the patient may be distressed or frightened by the CT machine.

To prepare for the MRI or CT examination, the patient undergoes a physical and medical history examination. Afterward, the radiologist administers a sufficient dose of sedatives, most commonly dexmedetomidine, chloral hydrate in oral form, or benzodiazepine, which then reduces the patient’s anxiety and irritability.

4. Dental Procedures

Sedation finds itself deeply rooted in dental practice. Also called sedation dentistry, it involves delivering sedatives in sufficient quantities, so the patient is technically awake but relaxed throughout the dental procedure. It’s also sometimes called twilight sleep because it depresses awareness to the level where the patient feels insensitive to pain without losing consciousness.

Prior to the procedure, patients with dental anxiety and/or those undergoing lengthy treatments typically receive medications to calm their worries and prepare them for the process. But before that can happen, the dentist must evaluate their previous medical history, including current medications, adverse effects from using sedatives in the past, previous diseases, and alcohol use, among others to determine if any of these factors might affect the outcome of sedation.

If they’re deemed fit, the dentist will administer medications typically in the form of nitrous oxide, oral sedation, or intravenous sedation. After sedation is administered and the procedure is complete, the patient’s vital signs must be monitored regularly until the patient reaches the criteria for recovery.

5. Vascular Imaging

Vascular imaging deals with the use of medical imaging techniques to guide doctors as they diagnose and treat diseases associated with blood and lymph vessels. While most vascular imaging procedures are non-invasive (meaning the radiologist will either make no incision at all or a very small one), it is sometimes necessary to administer sedation to reduce unwanted movements from the patient that can affect the outcome of the procedure and to alleviate the patient’s anxiety/discomfort.

To achieve moderate sedation, the radiologist will choose between several medications, depending on the patient’s assessment results and risk factors. In many cases, fentanyl or midazolam are ideal drugs for interventional procedures because they have a rapid onset of action (typically below three minutes) and a short duration of effect (less than 60 minutes).

To ensure patient safety, vital signs are recorded before and after any drug administration and recorded at five-minute intervals until the patient enters a stable level of sedation. Then once the procedure is over, post-procedure monitoring is carried out until the patient reaches baseline consciousness.

6. Tissue Biopsy

In many cases, sedation isn’t required during biopsies but rather a local anesthetic to numb the biopsy site. However, when a patient is overly anxious about undergoing the procedure, the healthcare provider will administer a sedative to help them relax without affecting their ability to respond to stimulation.

Before administering the sedative, the patient must undergo an assessment to evaluate their medical history, current medications, allergies, and other factors that determine the risk of sedation. Once the procedure is ready to begin, the healthcare provider will monitor the patient’s safety by tracking their vital signs, including heart rate and blood pressure.

After the patient is cleared, the sedative is administered. Due to the nature of this procedure, the sedative is often administered intravenously to ensure rapid onset, and the dose is adjusted based on the patient’s response and vital signs. Once the patient is adequately sedated and the biopsy site is numb, the tissue biopsy is then performed elaborately.

Conclusion

To recap, moderate sedation refers to the drug-induced level of consciousness during which a patient is particularly asleep but wakes when spoken to or touched repeatedly. Contrary to what many think, sedation isn’t a medical procedure used only for invasive surgeries. Rather, you’ll find it being applied in a range of routine health screening procedures, from colonoscopies to dental procedures, tissue biopsies, radiology imaging, and more.