What is conscious sedation (moderate sedation)?

From the Guidelines

Conscious sedation, also known as moderate sedation, is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands or light tactile stimulation. According to the guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update 1, moderate sedation is characterized by the ability to respond purposefully to verbal commands, with no intervention required to maintain a patent airway and spontaneous ventilation being adequate.

Key Characteristics of Conscious Sedation

• Patients respond purposefully to verbal commands or light tactile stimulation
• No intervention is required to maintain a patent airway
• Spontaneous ventilation is adequate
• Cardiovascular function is usually maintained

The American Academy of Pediatrics (AAP) guidelines 1 emphasize the importance of understanding the definitions of terms used in sedation, including minimal sedation, moderate sedation, deep sedation, and general anesthesia. Moderate sedation implies an interactive state for older patients and age-appropriate behaviors for younger patients, with reflex withdrawal not considered the only age-appropriate purposeful response 1.

Management and Monitoring

The guidelines also discuss the management and monitoring of patients during and after sedation, including the use of a suitably equipped recovery facility, continuous monitoring of vital signs, and the provision of supplemental oxygen and resuscitation equipment 1. Patients who have received sedation should be monitored until they return to baseline mental status and vital signs are stable, and should not drive or make important decisions for 24 hours after receiving sedation 1.

Overall, conscious sedation is a safe and effective way to manage anxiety and pain during medical procedures, with a low risk of complications when properly managed and monitored 1. The key to successful conscious sedation is careful patient selection, proper medication administration, and continuous monitoring of vital signs, as outlined in the AAP guidelines 1.

From the FDA Drug Label

For the reversal of the sedative effects of benzodiazepines administered for conscious sedation, the recommended initial dose of flumazenil injection is 0.2 mg (2 mL) administered intravenously over 15 seconds. Conscious Sedation in Adults Flumazenil was studied in four trials in 970 patients who received an average of 30 mg diazepam or 10 mg midazolam for sedation (with or without a narcotic) in conjunction with both inpatient and outpatient diagnostic or surgical procedures

Conscious sedation (moderate sedation) is a state where patients receive benzodiazepines for sedation, with or without a narcotic, in conjunction with diagnostic or surgical procedures.

• It is characterized by the administration of benzodiazepines, such as diazepam or midazolam, to achieve a desired level of sedation.
• The goal of conscious sedation is to provide a state of relaxation and reduced anxiety, while still allowing the patient to respond to verbal commands and maintain a patent airway.
• Key features of conscious sedation include:
  • Administration of benzodiazepines for sedation
  • Use in conjunction with diagnostic or surgical procedures
  • Patient remains responsive to verbal commands
  • Patient maintains a patent airway 2 2

From the Research

Definition of Conscious Sedation

Conscious sedation, also known as moderate sedation, is a minimally depressed level of consciousness during which the patient retains the ability to independently and constantly maintain an airway and respond appropriately to verbal commands [ 3, [ 4 ].

Characteristics of Conscious Sedation

The key characteristics of conscious sedation include:

• The patient is able to respond to verbal commands
• The patient is able to maintain a patent airway
• The patient is able to ventilate spontaneously
• The patient is able to maintain cardiovascular stability [ 5, [ 6 ].

Medications Used for Conscious Sedation

Various medications can be used for conscious sedation, including:

• Midazolam [ 3, [ 4, [ 5, [ 6 ]
• Fentanyl [ 3, [ 5, [ 7 ]
• Propofol [ 4, [ 6, [ 7 ]
• Sevoflurane [ 4
• Nitrous oxide [ 4

Procedures That Use Conscious Sedation

Conscious sedation can be used for a variety of procedures, including:

• Electrophysiology procedures [ 3
• Endoscopic procedures [ 4
• Surgical procedures [ 4, [ 7
• Subcutaneous implantable cardioverter-defibrillator implantation [ 6
• Aesthetic surgery [ 7