Sedation

Human consciousness can be described as a “continuum”. In the same sense, depth of sedation may be described as a continuum where levels blend into each other so gradually and seamlessly that it is impossible to say where one becomes the next.

There are four generally accepted terms to describe depth of sedation/anesthesia: “Minimal Sedation”, “Moderate Sedation”, “Deep Sedation”, and “General Anesthesia”. There are four descriptive parameters used to determine level of sedation: responsiveness, ability to protect and maintain one’s own airway, the ability to generate adequate spontaneous ventilation, and changes in cardiovascular function.

These are GENERAL descriptions of each level or depth of sedation:

  • Minimal Sedation is a light form of anesthesia usually achieved through taking medication, usually a pill(s), by mouth. Patients rarely lose consciousness and are awake, can talk and respond to questions and commands appropriately, breathe effectively on their own, and generally have negligible effects to “vital signs” such as heart rate and blood pressure. Patients should, however, feel less anxious and/or fearful, and have a general sense of well-being. These medications can make patients feel drowsy and tired enough to fall asleep, but normal interaction during the procedure is usually enough to keep the patient awake. Once taken, these medications can also sometimes produce memory loss of the procedure.

  • Moderate or Conscious Sedation is a level of anesthesia which requires medication(s) given intravenously (IV). This requires placement of an IV before the procedure so that medications may be given to induce and maintain an adequate level of anesthesia throughout the procedure. Moderate sedation is characterized by a depth of anesthesia in which a patient has a “purposeful” response to being talked to or being touched, is able to breathe effectively without assistance, and usually has no changes in vital signs. Intravenous medications are generally stronger and are able to generate a deeper, more reliable level of anesthesia than oral medications. This includes a much more profound loss of anxiety and feeling of well-being.  In this state a patient is much more likely to be overcome by sleep and to have no recollection of the actual procedure. However, not all patients experience amnesia.

  • Deep Sedation also requires administration of anesthetic medication through an IV. Deep sedation is attained with loss of consciousness. Patients may be responsive, but only to intensely noxious stimuli, and usually cannot respond appropriately or follow commands. The ability to breathe and exchange breaths is usually maintained but may require some intervention or assistance. Effects on vital signs are usually minimal but can fluctuate; therefore, vital signs are monitored at frequent intervals. Patients under deep sedation are, in effect, asleep. With loss of consciousness there is no anxiety, no fear and entirely no memory of the procedure. Patients are sometimes induced under deep sedation and “wake up” at the end of the procedure having no idea that the procedure was even performed.

  • General Anesthesia also necessitates placement of an IV.  General anesthesia is characterized by complete loss of consciousness, unable to awake even to severely painful stimuli. Patients frequently cannot maintain their own airway and respiratory depression is commonly profound, therefore, some intervention is usually taken to secure a patent and/or protected airway. This includes, but is not exclusive to endotracheal intubation. Medication(s) used to achieve general anesthesia can affect the cardiovascular system and therefore, vital signs must be monitored at frequent intervals. Patients under general anesthesia have complete amnesia to the procedure.

Different patients, as well as different procedures, require different levels of anesthesia. At Preferred Sleep Anesthesia LLC (PSA), we use highly trained Certified Registered Nurse Anesthetists (CRNAs) who are extensively trained to perform anesthesia specifically tailored to the patient, procedure, and the physician.

As described, depth of anesthesia is measured on a continuum, where it is very easy to inadvertently and unknowingly reach a level of anesthesia deeper than what is called for, or is safe. It is for this reason, that anyone performing anesthesia should be skilled and trained to deliver an anesthetic level one grade deeper than planned, and be able to rescue a patient from that level of anesthesia if need be. Our CRNAs are trained to perform anesthesia of every level and they do so every day.  

Let our CRNAs perform your moderate IV sedations while you concentrate on the procedure at hand. Not all doctors and physicians are trained and certified to perform their own deep sedation. By using our CRNAs you don’t have to worry about the extra education courses and certifications. Our CRNAS are already certified and able to perform any level of anesthesia in your office, clinic, or ambulatory surgery center.

PSA does not contend that properly trained doctors and physicians cannot safely perform their own anesthesia in their own office. We only assert that using a CRNA from Preferred Sleep Anesthesia, LLC. for your patients who need anesthesia will make your practice more efficient, your procedures less stressful, and your patients less anxious. As professionals who know how strenuous it can sometimes be to perform anesthesia on its own, we can see how trying to perform a procedure while controlling a patient’s sedation and comfort can be an arduous process. However, many doctors and physicians don’t realize the benefits of having a CRNA provide anesthesia services because they’ve always done it themselves. One of the greatest compliments we get when we go to a new office is “WOW, I never thought I needed you until I used you”. Many doctors and physicians have come to realize the benefits of using a Preferred Sleep Anesthesia LLC CRNA in their own offices.

Please call us or make an appointment to talk about the specific anesthesia needs of your practice.