Sedation: Is it getting easier?

As medicine moves towards less invasive and fast track options, there is a steadily increasing call for the provision of sedation rather than general anaesthesia for diagnostic and therapeutic procedures. This is a result of reduced staffing, funding and inpatient facilities. 12% of in-patient procedures (and 40 –50% of out-patient surgeries) in the USA in 2001 were performed under some form of sedation. Sedation is, however, not a static or easily achieved entity. It lies at a variable distance along the continuum from the awake state to general anaesthesia, depending on the extent of sedation. Patients may move from one level to another with top up doses, or infusions, or with changes in level of stimulus – intra-patient variation. In addition, there is wide interpatient variation in response to a given dose of a given drug or combination. The levels of sedation as defined in the South African Society of Anaesthesiologists (SASA) practice guidelines are tabulated below but are easier to describe than to achieve.