Sedation

As part of the Sedation the patient is given a sedative and sedative drug. In this way, fears and stress reactions can be controlled. Most often, sedation is used in the context of anesthesiological premedication and in this case it gradually changes into general anesthesia.

What is sedation?

With sedation, the doctor gives the patient a sedative. This is a calming drug that downregulates the functions of the central nervous system. Treatment with a tranquilizer must be distinguished from this. Such tranquilizers are anti-anxiety and relaxing psychotropic drugs from the same group of drugs. In the broadest sense, they can also theoretically be used for sedation.

As a rule, however, they are used in low doses and are used in particular to relax in conflict situations and muscle spasms. Anesthesia should also not be confused with sedation. Anesthetized patients cannot be awakened for the duration of the anesthesia. Sedated patients, on the other hand, are generally awake. Usually there is a smooth transition between sedation and anesthesia.

This means that the patient is first sedated and then transferred from sedation to anesthesia. The doctor often gives a pain reliever in addition to the sedative. In such a case, there is also talk of analgesic sedation. In addition to artificial substances, some purely herbal substances are also available for sedation. Herbal forms of sedation use non-prescription substances and can even be carried out on your own.

Function, effect & goals

Sedations are intended to calm the patient down. Restlessness is one of the most common symptoms that accompany many mental and physical illnesses. The sedative relieves these kinds of restlessness and can promote sleep. For example, those at risk of suicide or severely psychotic patients receive sedation as standard.

In the case of psychoses, sedation can lead to a distancing from the respective fears. Sedatives given in large quantities cause the patient to lose conscious awareness almost entirely. This also eliminates the patient's fears. In this context, sedatives are an important aid before operations. In this context, the doctor also speaks of anesthesiological premedication in the case of sedation. But they are also given before therapeutic and diagnostic procedures. The stress level before these measures would often be too high without sedation. Slightly sedated patients remain responsive, but are still relieved of stress. Sedatives can also be given for severe pain.

Sedations play a special role in general intensive care medicine. For example, if a patient is to be ventilated, this would hardly be possible without deep sedation. The ventilation measures are usually not tolerated by a non-sedated organism. Seditiva differ in their dosage and their type of drug with the intended use. The form of administration also depends on the intended use and, above all, the type of sedative. Most sedatives, however, are administered orally or intravenously. In addition to benzodiazepines such as diazepam, antidepressants such as trazodone, narcotics such as propofol and barbiturates such as phenobarbital are available for sedation. Neuroleptics such as promethazine and opioids such as morphine can also be used.

In general, alpha-2 adrenoceptor agonists such as clonidine are now mainly used for sedation. In individual cases, however, H1 antihistamines such as hydroxyzine or purely herbal sedatives such as valerian are used. The deeper the sedation, the longer it lasts. A correspondingly high dose is necessary to achieve deep sedation. To accurately plan the dose, depth, and duration of sedation associated with a particular sedative, doctors typically use the Richmond Agitation Sedation Scale or the Ramsey Score.

The guidelines of the DGAI can also specify the framework for sedation measures. The S3 guideline in particular is currently used to coordinate the measures. Unlike the Ramsey Score, this guideline offers almost one hundred percent reliability.

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Risks, side effects & dangers

Overdosing on sedatives can lead to a complete loss of consciousness. This phenomenon can be deliberate under certain circumstances. In other cases, this transition to general anesthesia is unwanted and poses risks for the unprepared doctor. To avoid this, the doctor must take appropriate protective measures in advance. Deep sedations usually take place under intensive medical supervision.

Above all, this should minimize the risk of switching off the patient's protective reflexes through sedation or provoking respiratory and circulatory depression. One problem with prolonged administration of sedatives is tolerance.After a certain period of time, this leads to immunity and the doctor has to increase the dose of the drug in order to maintain the desired depth of sedation. In long-term use, sedatives also harbor a high risk of abuse and addiction. An exception in this case are neuroleptics, which are not associated with addictive potential. With deep sedation there is a risk of circulatory collapse and respiratory arrest due to the complete loss of consciousness.

For this reason, particularly deep sedations usually require additional ventilation and the maintenance of the cardiovascular system with catecholamines. As a rule, the patient must agree in writing to planned sedation. Exceptions in this context are suicidal and psychotic patients. In individual cases, sedatives do not have the desired effect. The administration of the aids sometimes creates an even greater restlessness in the patient. In extreme cases, the sedated person can no longer be guided and controlled.