Procedural Sedation

What is procedural sedation?

Procedural sedation is used to calm a person before and during a procedure. It involves giving you sedatives or pain medicines. These medicines ease discomfort, pain, and anxiety. They are usually given through an IV (intravenous) line in your arm. Or you may swallow or get them as an injection.

While you are under this type of sedation, you will have your procedure. Your medical team will carefully observe your heart, blood pressure, breathing, and oxygen saturation. Most of the time you are awake but very sleepy. But you may not remember anything afterward.

The level of sedation can vary. It can range from very little to fairly deep sedation. People who need only a little can respond normally to questions and requests. If you get a deeper level of sedation, you may need some stimulation to respond. You are not put into a state of deep sleep. That’s called general anesthesia.

Why might I need procedural sedation?

The technique and medicine are used for a lot of procedures. The goal is to reduce pain, anxiety, and unpleasant memories of a procedure. It can also make a procedure more effective. For instance, feeling relaxed may make it easier to fix a broken bone.

Procedural sedation is used only for short, straightforward procedures. It's not used for complex surgeries. Some procedures that use this type of sedation include:

• Bone or joint realignment to fix a broken bone or dislocated joint

• Breast biopsy to evaluate a lump in the breast

• Bronchoscopy to evaluate lung conditions

• Dental surgery

• Electrical cardioversion to restore a normal heart rhythm

• Endoscopy to evaluate gastrointestinal problems

• Lumbar puncture to check for neurological disease

• Minor foot or skin surgery

What are the risks of procedural sedation?

Procedural sedation is a fairly safe practice. Your own risks may differ somewhat. They are based on your age and any other health conditions you may have. They also depend on the type of sedation you are given.

Some possible side effects are:

• Changes in heart rate and blood pressure (rare)

• Decreased rate of breathing

• Decreased oxygen saturation level

• Headache

• Inhalation of stomach contents into your lungs (rare)

• Nausea and vomiting

• Unpleasant memory of the experience

Side effects are usually not serious. Your medical team can prevent many of them by watching you closely during your procedure. Some of the side effects often go away shortly after the procedure.

How do I get ready for procedural sedation?

You'll be told how to prepare for your procedure. Let your healthcare provider know about the following:

• Your health history

• Any past problems with sedation or anesthesia

• Any recent symptoms, such as a sudden fever

• Any medicine you're taking, including prescription medicines, over-the-counter medicines such as aspirin, or any vitamins, herbs, or supplements

If needed, you should stop smoking before your procedure. That will help lower your chance of problems. You should follow your healthcare provider's instructions about when to stop eating and drinking before your scheduled procedure. Procedural sedation may still be used in the case of an emergency even if a person has eaten recently. You’ll also need to arrange to have someone available to drive you home afterward.

In some cases, you may need other tests to check your health before your procedure. These might include:

• Basic blood work to check for anemia and infection

• Chest X-ray to view your heart and lungs

• Electrocardiogram (ECG) to check your heart rhythm

What happens during procedural sedation?

Ask your healthcare provider about what to expect when you are sedated. Only those who are specially trained in sedation will do it. You might have the procedure in a hospital, an outpatient surgery facility, an emergency room, a healthcare provider's office, or even a dental office.

In general, you can expect the following:

• You will be given medicine through an IV line (often through a vein in your arm). Or you may get a shot. The medicine may also be given by mouth with a sip of water.

• If you receive medicine through an IV, you may feel the effects very quickly.

• You should start to feel relaxed and drowsy.

• Your breathing and blood pressure may drop a little. But you shouldn’t need help with your breathing. You might receive a little extra oxygen through a mask.

• Throughout the procedure, your heart rate, breathing, blood pressure, and oxygen saturation level will be closely watched.

• You will likely stay awake the entire time. If you do fall asleep, you should be easy to wake, if needed. You should feel little or no pain.

• When your procedure is over, the medicine will be stopped. You should return to normal consciousness fairly quickly. If it takes longer than expected to wake after the procedure, special IV medicines may be given. This is to reverse the effects of the sedation medicines.

What happens after procedural sedation?

You may have a dim memory of the procedure. Or you may not remember it at all. Depending on the medicines used for sedation, you will likely be drowsy for a while afterward. You will be closely watched as you become fully awake and alert.

You should be able to go home within 1 or 2 hours after your procedure. Plan to have a responsible adult drive you home and stay with you for at least a few hours. Depending on the reason for your sedation, you may get more directions. For example, you may need to keep the area of a surgical incision elevated.

Side effects like headache and nausea often go away quickly. But tell your healthcare provider if they persist. Depending on the type of procedure you had, you may need to take pain medicine.

You can usually go back to a normal diet and most of your regular activities soon after the procedure (depending on the procedure being done). But don’t drive, operate dangerous machinery, or make any important decisions for at least 24 hours. Be sure to follow all after-care instructions. Also take any medicine as directed. Depending on your procedure, you may need more treatments or follow-up procedures.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure