Obtained with sedative, analgesic, hypnotic and / or anesthetic drugs, conscious anesthesia is used during minor surgery (eg: reconstructive surgery) and slightly invasive diagnostic procedures (eg: endoscopy or colonoscopy).
Conscious anesthesia is becoming an increasingly adopted practice, because it combines safety with efficacy, does not induce loss of consciousness at the time of its execution, produces a mild confusion that disappears quickly, and does not necessarily require the presence of an anesthetist.
In other words, conscious anesthesia is the anesthesia that sedates and numbs patients to pain while keeping them fully awake and alert.
Conscious anesthesia is a decidedly lighter variant of general anesthesia, in which the patient loses consciousness and falls asleep.
, would cause pain for which it would be excessive not to adopt any countermeasures, just as it would be excessive to resort to general anesthesia.Conscious Anesthesia and Minor Surgery
Among the minor surgical procedures for which conscious anesthesia represents an excellent resource, there are:
- Minor foot surgeries;
- Minor operations on the skin;
- Operations for the reduction of minor bone fractures;
- Plastic or reconstructive surgery (eg: myringoplasty and reconstruction of the earlobe);
- The transvenous installation of a cardiac pacemaker;
- Operations to reduce joint dislocations;
- Ophthalmological surgery, such as the application of intraocular lenses or blepharoplasty;
- Dental surgery (eg: reduction of a dental abscess) and dental-reconstructive (eg: dental implant).
Conscious Anesthesia and Slightly Invasive Diagnostics
In the diagnostic field, conscious sedation is an increasingly exploited practice on the occasion of:
- Endoscopy. It is the diagnostic technique which, through the use of an instrument equipped with a video camera (endoscope), allows to view the esophagus, the stomach and the very first part of the intestine from the inside.
- Colonoscopy. Similar to the instrumentation used for endoscopy, is the diagnostic technique that allows to study the various parts of the large intestine (colon, sigmoid and rectum) from the inside.
- Bronchoscopy. Based on the use of an instrument very similar to that used for endoscopy and colonoscopy, it is the diagnostic procedure that allows to analyze from the inside the airways of greater caliber (larynx, trachea and bronchi).
- Cystoscopy. It is the diagnostic procedure aimed at exploring from the inside of the urethra walls and, above all, the bladder. The instrument for its implementation broadly follows that of endoscopy and the other previously mentioned practices.
- Transesophageal echocardiogram. It is the ultrasound of the heart which involves the insertion of the ultrasound probe into the esophagus, which are fundamental for this type of radiological examination.
Compared to the classic transthoracic echocardiogram (where c "is an external use of the ultrasound probe), the transesophageal echocardiogram provides much more detailed images, but it is also more invasive. - Angiography. It is the radiological diagnostic test (using X-rays), which allows to study morphology, course and possible anomalies of the blood and lymphatic vessels.
- Breast biopsy. It is the diagnostic procedure that consists in the collection and in the laboratory analysis of a sample of cells belonging to the mammary gland. It is fundamental for the diagnosis of breast cancer.
As a rule, the medical checks in question must take place one week before the presumed date of the operation under conscious anesthesia, so that there is plenty of time to: carefully evaluate the blood and urine samples; make temporary changes to any drug intake finally, in case of impediments to conscious anesthesia (eg allergy to a certain drug used to obtain the latter), discuss the solutions.
Do's and Don'ts just before Conscious Anesthesia
On the day the conscious sedation procedure takes place, the patient should:
- Have a complete fast for at least 6-8 hours. This means that, for the interventions in conscious anesthesia scheduled in the morning, the last meal allowed is the dinner of the previous evening. conscious anesthesia;
- Show up accompanied by a close family member or friend. The family member (or "friend) is used to support the patient at the end of the procedure, just before returning home and during the return home. Although light, in fact, conscious sedation alters, in a completely temporary way, reflexes and the ability to concentrate, which is needed to be independent and carry out activities such as driving.
Timing
To obtain conscious sedation - that is, to benefit from its relaxing and anti-pain effects - a "wait of 5-10 minutes at most, except in special cases, is sufficient.
Conscious anesthesia has a limited duration in time, a duration which is in any case sufficient for the execution of the therapeutic and diagnostic procedures for which the anesthetic practice in question is indicated.
When does the wait for conscious anesthesia get longer?
If the route of administration is oral, the wait to observe the first effects of conscious anesthesia can vary from 30 to 60 minutes, depending on the drugs used.
The Drugs for Conscious Anesthesia: the details
Among the drugs most used in the implementation of conscious anesthesia, there are:
- Propofol. It is an anesthetic / hypnotic.
- Ketamine. It is an analgesic.
- Midazolam. It is a short-lasting analgesic, with also anxiolytic effects;
- Fentanyl. It is an analgesic with mild sedative effects;
- Dexmedetomidine. It is a sedative / analgesic.
As already stated, in order to achieve conscious sedation it is necessary to properly combine two or more of the aforementioned drugs.
The choice of the drug combination is up to the doctor and is by no means random, but depends on the patient's characteristics (age, weight, drug allergies, etc.).
The most popular combination of drugs in "obtaining" conscious anesthesia is that of a sedative (in particular, midazolam) and an analgesic (in particular, fentanyl).
What are the patient's sensations during Conscious Anesthesia?
Once conscious anesthesia medications have taken action, you are very likely to see a decrease in respiratory rate and a slight drop in blood pressure.
However, these changes should not scare, because they are normal consequences of the drugs in use and because they are constantly monitored by a member of the medical staff (who constantly checks that the patient's vital signs do not vary excessively).
During the procedures under conscious anesthesia, the medical staff connects the patient to machinery and devices for measuring and monitoring blood pressure, blood oxygen levels, heart rhythm and respiratory rate.
The patient, therefore, finds himself in a safety situation.
Who executes it?
Conscious anesthesia is a practice that can be performed both by the doctor who will take care of the therapeutic or diagnostic procedure, and by an anesthetist (ie a doctor specialized in anesthesiology).
and confused, have a slight headache and feel stomach ache.All these sensations are transient and vanish in the hours following the anesthetic practice.
As a rule, those who have received conscious anesthesia can return home 1-2 hours after the conclusion of the procedure, which saw the use of the anesthetic practice in question.
Before returning home
Practice dictates that, while waiting to go home, the patient subjected to conscious sedation is subject to periodic monitoring (every 15 minutes) of blood oxygen levels and arterial pressure.
At home
Once discharged, the patient recovering from conscious anesthesia should:
- Eat in a healthy and balanced way to recover better;
- Rest until the next day, at which time your strength will be fully restored;
- Avoid driving and engaging in other activities that require some concentration;
- Avoid drinking alcohol;
- If undergoing surgery, strictly follow the instructions of the attending physician.
The precise picture of possible side effects and possible complications depends on the drugs used for conscious sedation, as these drugs do not all present the same risks.
; however, it should be specified that, in people with an "allergy to the drugs necessary for its implementation, specific anti-allergic countermeasures must be adopted.
