Sedation and General Anesthesia

WHAT IS SEDATION?

Sedation is a supportive treatment applied by an anesthesiologist for the comfort, increased tolerance, and calming of the patient in procedures performed with local anesthesia. It includes drug administration to relax the patient. It is especially commonly used in pediatric patients.

The sedated child will better tolerate and probably not remember anything about the procedure. If the procedure is supposed to be painful, sedatives can be combined with painkillers. Depending on the level of sedation, the patient may remain in communication (conscious sedation) or be placed in a deeper state of sleep. In both cases, the patient will continue to breathe on their own.

ARE THERE DIFFERENT LEVELS OF SEDATION?

Three levels of sedation have been defined. The type of sedation is decided by the clinician depending on the duration and type of the procedure.

Minimal sedation: The patient can respond normally to verbal commands. Minimal sedation aims to reduce anxiety and may be suitable for quick, painless procedures.

Moderate sedation: The patient is sleepy but responds to loud stimuli. Sedatives can be administered orally or intravenously.

Deep sedation: The patient is completely asleep but may respond to repetitive stimuli.

WHAT IS THE RAMSAY SEDATION SCALE?

Dental procedures are ideally performed under moderate sedation with a Ramsay score of 3.
However, deeper sedation, with a Ramsay score of 4, may be a better option for children for an easier operation.

Levels of ‘awake’ states:

1 Anxious, agitated, restless
2 Co-operative, oriented, tranquil
3 Responds to commands only

Levels of ‘asleep’ states
4 Brisk response to light glabellar (forehead) tap or auditory stimulus
5 Sluggish response to light glabellar (forehead) tap or loud auditory stimulus
6 No response

WHAT IS GENERAL ANESTHESIA?

General anesthesia is a profound sleep-like state without pain. General anesthesia is sometimes given after a tranquilizer. In the operating room, a fast-acting anesthetic is administered intravenously. The anesthesia is maintained with anesthetic gases or drugs, depending on the duration of the procedure.

The patient receives respiratory support during the procedure via a laryngeal mask airway (LMA) or an endotracheal tube (ETT) and a mixture of oxygen and anesthetic gases. After the procedure is completed and the anesthetics are discontinued, the patient will wake up.

Upon waking up, the patient is asked to swallow the saliva in their mouth and and to take a few deep breaths. The anesthesiologist will take the necessary measures to prevent any adverse events that may occur after the procedure, such as pain, nausea, or vomiting. The functions of vital organs (as determined by pulse, blood pressure, respiration, and oxygenation) are constantly monitored during and after anesthesia.

SEDATION VS. GENERAL ANESTHESIA

Sedation is different from general anesthesia. General anesthesia creates a profound state of sleep where the patient will not respond to any stimulus.

Moreover, general anesthesia depresses the respiratory system, thus requires respiratory support. During sedation, the patient can respond to verbal commands or repetitive stimuli depending on the level of sedation, and continue spontaneous respiration (i.e., respiration is not depressed).

CAN EVERY CHILD BE SEDATED?

No. Sedation is only applicable to some children. For example, sedation is risky if your child has a serious medical problem. In these cases, general anesthesia in the operating room is a safer option.

Sedation is suitable for shorter (less than 1 hour), less painful procedures, and for healthy children. General anesthesia should be preferred in procedures that exceed 1.5-2 hours that are expected to cause severe pain.

AFTER SEDATION

Sedation is achieved using low-dose anesthetics. For this reason, the patient is kept under observation after the procedure is completed until the drugs completely wear off. Patients who are awake and well-oriented are sent home provided that their vital signs (pulse, blood pressure, oxygen saturation) are normal.

Patients with an impaired mental state (mentally retarded, Alzheimer’s disease, etc.), are not expected to be fully alert, but to return to their initial state. Your physician will tell you how long you need to wait before eating or drinking. Usually, you can start eating small amounts of soft foods after a few hours.

The patient must be accompanied by an adult when they are sent home. Patients who have received sedation or general anesthesia should be advised not to drink alcohol, drive, or use heavy machinery, to stay away from sharp tools, and not to sign any documents within 24 hours after the procedure. You can resume your normal medications after the procedure is completed, if any.

WHAT ARE THE RISKS AND SIDE EFFECTS OF GENERAL ANESTHESIA?

Although rare, it is possible that a healthy person will develop an adverse reaction to anesthesia. These side effects are usually temporary but may cause chronic complications.

Nausea, vomiting, headaches, pain, swelling, or bruising at the injection site, dryness or tenderness in the throat and lips, double or blurred vision, dizziness, etc. are common after anesthesia. Muscle pain, weakness, itchiness, and redness are less common side effects.

Other, more rare complications include awareness under anesthesia, damage to teeth, dental prostheses and lips, damage to the vocal cords, allergic reaction and asthma attack, venous clot, compression and nerve damage, and epileptic seizure.

During anesthesia, there is a risk of death, albeit rare, due to adverse events, such as severe allergies or anaphylactic shock, malignant hyperthermia, stroke or heart attack, asphyxia due to choking of stomach contents, pulmonary embolism, brain damage, or arrhythmias.

The risk of anesthesia increases with advanced age, having a cold, asthma or other lung disease, smoking, being overweight, diabetes, kidney disease, high blood pressure, and other chronic diseases.

BEFORE SEDATION AND GENERAL ANESTHESIA

You must not eat or drink before sedation or general anesthesia. Do not eat, drink, or smoke for at least 8 hours before the procedure, unless otherwise recommended.

As long as you follow these instructions, your stomach will be empty in the event that you vomit under anesthesia, and there will be no risk of asphyxiation. Definitely do not eat or drink anything within the last 2 hours before anesthesia. If you are on medication, you can take it at your regular time with a small amount of water, after consulting with the anesthesiologist.

Remove your dentures, glasses, contact lenses, and jewelry before going into the operating room.

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