What is moderate sedation?
Moderate sedation can be used during procedures to help you feel relaxed and calm. Moderate sedation used to be called conscious sedation. With moderate sedation, your anxiety (worry) about your procedure decreases. You stay awake, and your breathing and heart rate do not change. You are able to follow commands and respond to questions during the procedure. Procedural sedation is when medicine is given to make you better able to cope with procedures that may be uncomfortable.
What minor surgeries may moderate sedation be used for?
- Biopsy: This may include removing samples of tissue from an area such as your breast (breast biopsy). The tissue is sent to a lab for tests.
- Cataract removal: A cataract occurs when the lens of your eye becomes cloudy. This causes your vision to get cloudy, hazy, and blurred.
- Fracture repair: If you have a broken bone repaired, you may be given moderate sedation.
- Incision and drainage: This is when a surgical incision (cut) is made in your skin to drain out pus that has collected in the area.
- Joint repair: Joints are places in your body where two bones meet, such as your knees and elbows. Car accidents, or injuries such as falls can cause your joint to go out of the place where it should be. To put the joint back into the right place, caregivers may give you moderate sedation.
- Surgery done on the skull or brain: You may get moderate sedation if you need surgery to open your skull (craniotomy), or surgery to treat seizures. You may also need moderate sedation if you get deep brain stimulation to treat Parkinson disease.
- Wound repair: You may be given moderate sedation to decrease pain if caregivers are cleaning or fixing an open wound. Open wounds can be burns, cuts, or skin scrapes.
What procedures may moderate sedation be used for?
During these procedures, samples of tissue or fluid may be collected, and other procedures may be done.
- Bronchoscopy: Caregivers may use this test to look inside your lungs and airway. For this test, a scope is put in your mouth and it is moved further down into your lungs.
- Colonoscopy: Caregivers use this test to look at your colon (large intestine). For this test, a scope is put into your anus, and then moved further into your colon.
- Endoscopy: Caregivers use this test to see the inside of your digestive tract. The digestive tract includes the mouth, esophagus, stomach, small and large intestines, and rectum.
- Sigmoidoscopy: Caregivers use this test to look for problems in the part of your colon called the sigmoid. For this test, the scope is put into your anus, and then moved further into your sigmoid colon.
- Thoracoscopy: Caregivers use this test to look inside your chest. For this test, the scope and other tools are put into one or more small cuts that are made in your chest.
What other procedures may moderate sedation be used for?
- Cardiac catheterization: This is a procedure done to find the cause of and treat a heart condition. A thin, bendable tube inserted into an arm, neck, or groin vein is moved into your heart. Your caregiver may use an x-ray to guide the tube to the right place. Dye (contrast) may be put into your vein so the pictures show up better on a monitor.
- Cardioversion: During this procedure, an electric shock is given to your heart. The shock is usually given through paddles or sticky patches placed on your chest or back. The shock helps your heart beat normally. Cardioversion may be needed if medicine does not make your heart work better.
- Dental procedures: Moderate sedation may be used for dental work. This can include having a tooth pulled, or getting a root canal.
- Foreign body removal: Foreign bodies are objects that get stuck in your ear, nose, mouth or other body opening. Objects such as coins, batteries, or nuts must be removed by a caregiver. Caregivers may give you moderate sedation while they remove the object.
- Lumbar puncture: During a lumbar puncture, you will need to lie very still while a needle is put into your back. Samples of fluid are collected from around your spinal cord and sent to a lab for tests.
What medicines may be given for moderate sedation?
Medicines used for moderate sedation may be given as a pill, shot, or through your anus. Medicine may also be breathed into your lungs, or given through an intravenous (IV) tube. An IV is a tube that is placed in your vein. You may be given one or more of the following medicines:
- Anesthesia: This is medicine that will help you feel more comfortable during surgery.
- Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
- Narcotics: This group of medicines may be given for pain during or after a procedure.
- Sedative: This medicine is given to help you stay calm and relaxed.
What are the risks of having moderate sedation?
- The medicine used for moderate sedation may cause you to get a headache or an upset stomach. The medicine might make forget things that have happened recently. The medicine may make your skin itchy, your eyes water, or they may increase your saliva (spit). Having too little medicine will make you uneasy and feel pain during the procedure. You may also feel like moving when you need to hold still. If the medicine does not wear off in a certain time, you may be given medicine to help you become more alert.
- If you get more medicine than you need, you may go into a deeper level of sedation. With deep sedation, you may need help breathing, and your blood pressure may decrease. Ask caregivers for more information about deep sedation. If you have heart or lung disease, or you have a head injury, you are at a higher risk having problems. These problems can happen during or after you get moderate sedation. Older adults, people who use illegal drugs, or those who drink too much alcohol too often are at a greater risk of having problems. Alcohol is found in adult drinks such as beer, wine and whiskey. Ask your caregiver if you have questions or concerns about having moderate sedation.
Who may not have moderate sedation?
You may not be able to have moderate sedation if:
- You are pregnant, or obese (weighing more than what your caregiver suggests).
- You are allergic to foods such as eggs and soybeans.
- You are allergic to the medicines that will be given.
- You have heart or lung disease.
- You have other medical problems such as head and neck cancer.
What should I expect before moderate sedation is used on me?
- Consent: You will be asked to sign a consent form that allows your caregiver to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that states what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
- Fasting: Fasting is not eating any food, or drinking any liquids for a certain time. If your procedure is planned ahead, ask your caregiver if you need to fast before it. Tell your caregiver when you last ate or drank. Your caregiver may ask you not to drink liquids at least two hours before sedation. A small meal may be eaten six hours before moderate sedation is given to you.
- Medical history: Your caregiver will ask you if you have had medical problems or surgeries in the past. Tell caregivers if you have any allergies, and about all the medicines that you use. Tell caregivers if you use street drugs or drink alcohol, such as beer and wine. If you are a female, tell your caregiver if you know or think you might be pregnant.
- Physical exam: Your caregiver will check your weight and vital signs. These include your temperature, and blood pressure, and he will also listen to your breathing.
What may happen while I am having moderate sedation?
During certain procedures, you may be asked to hold still, move around, or speak. Your blood pressure, breathing, heart rate, and temperature will be checked often. Your caregiver may look at your eyes, and ask you questions that will check your memory. Your handgrip and balance may also be tested. The medicine that you get during your procedure may wear off, and you may feel some pain. Your caregiver may need to give you more medicine.
What should I expect after I have moderate sedation?
You will be taken to a room where you can rest and caregivers will check on you. You may not be able to remember what happened during your procedure. You may be able to go home when you are fully awake and caregivers know that you are okay. If you are staying in the hospital, you will be taken to your hospital room. Do not get out of bed until your caregiver says it is OK. You may need any of the following:
- Capnography: This is a device that measures how much carbon dioxide (gas) comes out from your lungs. It will help your caregiver know if your lungs are working well.
- Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
- Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
- Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
What should I know when I go home after having moderate sedation?
- Do not drive a car or use heavy equipment. An adult should drive you home and stay with you.
- Follow caregiver's advice about making changes to your diet, activity, or medicine. Avoid hard exercise right after having moderate sedation. Do not drink alcohol, such as beer and wine. Do not make important decisions for 24 hours (one day) after having moderate sedation.
- Take antinausea medicine as ordered. This medicine may be given to calm your stomach and stop vomiting (throwing up). Pain medicine may make you feel like vomiting, so pain medicine and anti-nausea medicine are often given at the same time.
- Use ice chips. You may suck or chew small pieces of ice to decrease your need to cough.
- Use lip balm. Put lip balm on your lips to keep them moist. This will help prevent them from chapping.
When should I call my caregiver?
Call your caregiver if:
- You have a fever.
- You have a cough or headache.
- You have nausea or vomiting.
- You have questions or concerns about your condition, medicine, or care.
When should I seek immediate help?
Seek care immediately or call 911 if:
- You have sudden trouble breathing.
- You have a severe headache.
Where can I get more information?
Contact any of the following:
- American Pain Society
4700 W. Lake Avenue
Glenview , IL 60025
Phone: 1- 847 - 375-4715
Web Address: http://www.ampainsoc.org
- American Society of Anesthesiologists
520 N. Northwest Highway
Park Ridge , IL 600682573
Phone: 1- 847 - 8255586
Web Address: http://www.asahq.org
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. You always have the right to refuse treatment.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.