Critical care - Sedation assessment: Nursing

Sedation is a pharmacologically induced state of calm, relaxation, or sleepiness that alleviates the discomfort, anxiety, and agitation that’s often experienced by patients in critical care. It can be used to ensure patient safety during invasive procedures and to improve synchrony with mechanical ventilation.

Now, the levels of sedation include light sedation, moderate sedation, deep sedation, and general anesthesia. Light sedation is a minimal level of sedation that provides relief of anxiety. The patient’s cognitive function and physical coordination is slightly impaired, but they can respond to verbal commands, and their ventilatory and cardiovascular functions are not impacted. Light sedation is used during procedures that can make patients feel anxious, like during an MRI.

Next is moderate sedation, also known as conscious or procedural sedation. The patient’s level of conscious awareness is reduced, though they can respond purposely to verbal commands or to a tactile stimulus, like a gentle touch to the arm or hand. Patients can usually maintain their own airway but sometimes they may require supplemental oxygen. Cardiovascular function is also usually maintained. Moderate sedation can be used for procedures like certain tube or line insertions or endoscopic procedures.

Then there's deep sedation, where the patient’s consciousness is depressed to a point where they’re not easily aroused, but they can respond to repeated or painful stimuli. Patients can’t adequately maintain their own airway, so support is needed, like through intubation and ventilation. Cardiovascular function is usually maintained. This level of sedation is common in longer or more invasive procedures, like cardiac catheterization.

Lastly, general anesthesia is where the patient is completely unarousable. Patients can’t maintain their airway or breathing so they require full ventilatory support through intubation and ventilation. This type of sedation is used during complex and invasive surgical procedures, like an appendectomy or coronary artery bypass grafting.