SEDATION.

Sedation involves the use of drugs to remove anxiety. It is commonly used for endoscopy (examination of the stomach or colon) where it is normal for the endoscopist to give the sedation as well as perform the procedure. There are national guidelines set down to limit the amount of drugs used for safety reasons. This is often referred to as 'awake sedation'.

Anaesthetists are trained to safely care for patients who are totally unconscious so we can give combinations of drugs and use higher doses which results in more drowsiness. We can use these techniques to provide a spectrum of sedation from merely reducing anxiety through to general anaesthesia. Indeed, many of the drugs we use are anaesthetic agents.

Choosing between sedation and general anaesthesia

Some operations cannot be performed under sedation. These include operations inside the abdomen and many larger procedures.

Other procedures are safer under sedation; I normally insert lines and ports in adults under sedation as it reduces the risk of damage to surrounding tissues.

In some circumstances, the patient's condition may dictate one to be safer than the other; elderly patients may be advised to have sedation.

However, for the majority of cases where sedation is possible (eg podiatry or foot surgery and adult dentistry) we can use either general anaesthesia or sedation and the choice is up to the patient. I will only give you this choice if the level of risk is the same for either technique. Contrary to popular belief, general anaesthesia is NOT more dangerous than sedation.

Advantages and disadvantgages of sedation

Both techniqes involve the use of intravenous drugs. You will be connected to monitors and the start of the anaesthetic or sedation will be similar. With a general anaesthetic you lose consciousness completely and have no awareness of the operation. If you have sedation, you will become progressively more drowsy.

Sedation does not guarantee loss of awareness. You may be aware of movement, sound and vibration although we will also use local anaesthetic injections to ensure you have no pain. You may not remember these events afterwards as there is often retrograde amnesia.

Sedation does not produce nausea or vomiting afterwards, whereas the incidence of these side effects can be over 30% following general anaesthesia. Some people have a muggy feeling or feel 'hungover' after a general anaesthetic. This is unlikely after sedation.

On the other hand, sedation is not normally 'turned off' at the end of the operation .With a general anaesthetic you will be awake within a few minutes. If you choose sedation, it will take longer to regain consciousness.

Sedation may be feasible in a dental surgery and other locations. General anaesthesia in the UK is only undertaken in a hospital setting.

In both cases, you will need to stop eating and drinking beforehand and have an adult take you home if you are having a daycase procedure.

Conclusion

If your operation can be performed under either sedation or general anaesthesia, the choice is up to you. It is not a major decision because either is feasible and the level of risk is the same in these cases. If you have had a general anaesthetic in the past you will know how you felt afterwards and the same is likely after any future anaesthetics. Perhaps the core question is whether you want to be aware or totally unconscious.

I hope this page helps you to come to a decision. I will be happy to discuss it with you before your operation.

Back