Conscious Sedation

For most office-based or outpatient procedures is that “totally knocked out” isn’t really an option

“I want to be totally knocked out.”  I hear this frequently from patients who are to undergo invasive procedures and I can totally sympathize.  I very much dislike going to the dentist and I would just as soon be completely unconscious from the time I walk into the office until I get my smiley-face sticker at the exit.

The problem for most office-based or outpatient procedures is that “totally knocked out” isn’t really an option.  There are essentially two levels of sedation available in most settings.  The first is the “totally knocked out” variety and represents the level of deep sedation provided by anesthesiologists in the operating room setting.  It requires very close monitoring and sometimes involves the assistance of an artificial breathing machine (a ventilator).

The second and more common form of sedation is what we call “conscious sedation.”  It seems like something of an oxymoron, but it entails keeping your mind sedated while your heart and lungs remain fully conscious—hence, conscious sedation.  That is sometimes trickier than it sounds.  For many people there is no magic level of sedation that allows the thinking part of the brain to be totally unconscious without having the breathing part of the brain take a nap, too.

This can be made more complicated by other factors.  With our ever increasing national girth we are seeing more obese patients with underlying breathing problems like sleep apnea.  This is a disorder where people are in the habit of holding their breath when they drop into the deepest levels of sleep.  Once their oxygen drops to the level seen by Sir Edmund Hillary at the top of Mt. Everest their brain stimulates them to wake up and take a breath.  If I give that type of patient even modest amounts of sedation they tend to break into choruses of snoring and breath-holding.  It makes an otherwise simple case rather complicated.

As a doctor I really want you to be comfortable.  Nothing makes me happier after inflicting an invasive procedure than to have a patient say “You’re done?  I didn’t even know we had started!”  But as much as I am into customer satisfaction I am more interested in customer survival.  For this reason, I (and probably every other reasonable doctor) usually err on the side of safety and will keep you comfortable but somewhat less knocked out than you might hope.  At least you’ll get to wake up when I’m done with you.

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