Tt. Randell et Jv. Kytta, CONSCIOUS SEDATION IN PATIENTS UNDERGOING SURGICAL AND INVESTIGATIONAL PROCEDURES - A GUIDE TO DRUG CHOICE, CNS drugs, 10(5), 1998, pp. 329-342
Sedation is often required for a number of procedures to reduce patien
t anxiety, improve cooperation and ensure immobilisation when necessar
y. This article provides a concise summary of the recent developments
and current techniques of sedation during surgical and investigational
procedures. Sedative drugs can be given orally, rectally, sublinguall
y, as an inhalation or an aerosol, or by intramuscular or subcutaneous
injection. However, intravenous administration provides the most reli
able sedation. In routine practice, intravenous drugs are given in sma
ll bolus doses and titrated to effect. However, patient-controlled sed
ation with either propofol or midazolam has gained popularity in recen
t years. Target controlled infusion overcomes the problem of varying b
lood concentrations of the sedative drugs during the procedure, but th
e technique is currently used mostly in research. The ideal sedative d
rug provides reliable sedation without untoward adverse effects, and p
ropofol and midazolam meet most of the criteria for an optimal sedativ
e. The recovery from sedation is slightly faster with propofol, wherea
s midazolam provides better amnesia - the choice between the two drugs
remains at the discretion of the physician. Opioids or ketamine can b
e combined with propofol or benzodiazepines, especially in cases of se
dation for painful procedures, such as awake craniotomy, endoscopy of
the respiratory or gastrointestinal tract or for investigational radio
logy. Sedative drugs should always be administered by a trained practi
tioner, and the monitoring of the patient should include at the very l
east pulse oximetry and preferably also blood pressure measurement and
continuous monitoring of the electrocardiogram. Supplemental oxygen s
hould be routinely delivered during sedation.