Minimal sedation anxiolysis
Responsiveness: Normal response to verbal stimulation
Airway: Unaffected
Spontaneous ventilation: Unaffected
Cardiovascular function: Unaffected
Moderate sedation/analgesia (“conscious sedation”)
Responsiveness: Purposeful * response to verbal or tactile stimulation
Airway: No intervention required
Spontaneous ventilation: Adequate
Cardiovascular function: Usually maintained
Deep sedation/analgesia
Responsiveness: Purposeful * response following repeated or painful stimulation
Airway: Intervention may be required
Spontaneous ventilation: May be inadequate
Cardiovascular function: Usually maintained
General anesthesia
Responsiveness: Unarousable even with painful stimulus
Airway: Intervention often required
Spontaneous ventilation: Frequently inadequate
Cardiovascular function: May be impaired
Minimal sedation (anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes and ventilatory and cardiovascular functions are unaffected.
Moderate sedation/analgesia (“conscious sedation”) is a drug-induced depression of consciousness during which patients respond purposefully* to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Deep sedation/analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully* following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular funcation is usually maintained.
General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue** patients whose level of sedation becomes deeper than initially intended.Individuals administering moderate sedation/analgesia(“conscious sedation”) should be able to rescue** patients who enter a state of deep sedation / analgesia, while those administering deep sedation/analgesia should be able to rescue** patients who enter a state of general anesthesia.
* Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.
** Rescue of a patient from a deeper level of sedation than intended is an intervention by a practitioner proficient in airway management and advanced life support.The qualified practitioner corrects adverse physiologic consequences of the deeper-than-intended level of sedation – such as hypoventilation, hypoxia and hypotension – and returns the patient to the originally intended level of sedation.It is not appropriate to continue the procedure at an unintended level of sedation.
References
American Society of Anesthesiologists. (2018). Position on Monitored Anesthesia Care. Last amended on October 17, 2018.