الفهرس 
Different levels of sedationOnly 14 pages are availabe for public view
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Abstract
Conscious sedation is a technique that was originated in he practice of oral surgery and dentistry. It is popular and widely used to supplement local or regional anaesthesia during a variety of short term therapeutic and diagnostic procedures.
Conscious sedation may be defined as a medically controlled state of depressed consciousness that allows protective reflexes to be maintained, retains the patients to maintain a patent airway independently and continuously and permits appropriate response of the patient to physical stimulation and verbal commands.
Deep sedation is defined as a medically controlled state of depressed consciousness from which the patient is not easily arroused, it may be accompanied by a partial or complete loss of protective reflexes and inability to maintain a patent airway.
A wide variety of drugs are used to provide sedation and analgesia.
The ideal drug should have a rapid onset of action with a predictable dose-effect relationship with respect to its sedative-hypnotic actions. Excitatory effects should be minimal as should be its respiratory and cardiovascular depressant effects.
Drugs commonly used are Benzodiazepines, propofol, ketamine, short acting barbiturates, chloral hydrate, short acting opioids, local anaesthetics. Adjuvant agents as anticholinergic, antihistaminics, and anti-emetics.
A wide variety of routes of administration can be used (e.g. oral, nasal, parenteral or rectal) as well as techniques (e.g. Intermittent boluses, continuous infusion or patient controlled analgesia (PCA). Sedation and analgesia are required in the operating room for procedures done under local or regional analgesia (e.g. cosmetic surgery, cataract extraction, cystoscopy or breast biopsy).
Procedures performed outside operating room have problems in common as distant location, long transport to PACU, Awkward position of patients, remote monitoring and lack of help.
Conscious sedation is provided in many suites which are:
Electroconvulsive therapy:
Patients receive drugs which should be considered and contraindication for ECT should also be considered.
Cardiac catheterisation suite:
The anesthesiologist must know the indications of cardiac catheterization, the procedure, monitoring of complications.
Cardioversion:
Most cardioversions are scheduled in advance which allows for adequate preparation.
Radiology suite as:
• Computed Tomography (CT)
As it is not painful but the patient must remain still during examination, it is important for the anaesthesiologist to be familiar with the use of contrast media and expected side effects and how to manage.
• Magnetic Resonance Imaging (MRI): There are many problems facing the anesthesiologist.
• Anything near the scanner that contains ferromagnetic material will be attracted towards the scanner and become a flying projectile.
• Most electronic and anaesthesia equipment and monitoring devices don’t function properly when in close proximity to the magnet. So there is special monitors in MRI suite.
• Intervention radiography. Because of technical complexity of these cases and the risk of bleeding, close monitoring of the patient is important.
Dental suite:
We must consider if the sitting position in the dental chair is used the vasodialating and depressive, effect of anaesthetic agents may be pronounced in patients with pre-existing cardiovascular disease.
Monitoring of patients receiving conscious sedation include respiratory monitoring by pulse oximetry and capnography. Cardiovascular system is monitored by arterial pulse arterial-blood pressure and ECG. Temperature monitoring to prevent hypothermia and shivering which may be uncomfortable to the patient, this is achieved by a thermometer applied in the axilla as rectal or nasopharyngeal probes are impractical. C.N.S. monitoring by careful evaluation of the efficacy of conscious sedation in achieving the desired degree of analgesia, sedation and anxiolysis. Recovery room monitoring to. assess the residual effects of drugs administered and to determine when the patient is fit for discharge..
Sedation and analgesia for pediatrics require psychological preparation of the child, parents should be informed; of the procedure, medications, complications and should also he given a checklist to use in preparing the child for the procedure.
The dosage of sedative and analgesic drugs in this age group are higher on a per-kilogram basis. Drugs in common use are: midazolam, chloral hydrate, pediatric cocktail. pentobarbital or ketatnine.
Lastly, our goal is the safe use of conscious sedation and careful attention to prevention of complication.