CONSCIOUS SEDATION IN PATIENTS UNDERGOING SURGICAL AND INVESTIGATIONAL PROCEDURES - A GUIDE TO DRUG CHOICE

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.