So, just as promised, I want to go over the pros and cons of conscious sedation, so that if given the choice, you as a patient can make an informed decision about whether not to go completely to sleep for your surgery. First, I just want to more clearly define what I mean by "conscious sedation."
Conscious sedation refers to a level of anesthesia that is more than being completely awake, but less than being completely asleep. It is often referred to as "twilight" anesthesia, and the technical term for it is Monitored Anesthesia Care, called MAC for short. When patients receive MAC anesthesia, their consciousness is depressed somewhat. They have amnesia and are sedated enough that they may respond to very strong noxious stimuli but not much if at all to weaker stimuli. As opposed to a general anesthetic where the patient's breathing is significantly slowed down and their blood pressure can also decrease quite a bit, conscious sedation depresses these functions only mildly, if at all.
With that in mind, let's go over the good and bad of having conscious sedation.
The Good:
1. You're more awake during the surgery. In most cases, the amount of sedation you receive for such a case is enough that you don't remember anything, but not so much that you're totally out of it. Patients will sometimes remember hearing voices and the beeping sounds of monitors, but will note that they didn't really care about them and weren't worried or concerned about hearing them.
2. You wake up faster afterwards. The most common sedative administered during conscious sedation is propofol. Yes, that's the same drug that was misused by Michael Jackson, but in the hands of trained anesthesia professionals, it is a very safe drug. One of its best qualities is that it only lasts a few minutes, so during sedation it is given continuously into the IV via a small pump. When the surgery is done, the pump is discontinued, and the patient wakes up within a few minutes. There is little or none of the groggy feeling that so often accompanies general anesthesia.
3. Less nausea and vomiting. The stuff that really causes nausea is the combination of narcotics and the inhaled anesthetic gases that are used to maintain general anesthesia. With conscious sedation, there is no inhaled gas and significantly less narcotic being given.
4. Receiving less drugs = fewer side effects . General anesthesia is strong stuff. Even a "routine" general anesthetic involves the administration of some pretty potent medicines, ones that can drastically lower all bodily functions, including blood pressure, heart rate, neurologic function, even immune function. A general anesthetic is much more stressful on the body than conscious sedation.
The Bad:
1. You're more awake during the surgery. Again, the likelihood of remembering much at all during conscious sedation is quite small, but it's much more likely to happen than in general anesthesia. If you're the kind of person who wants to be totally knocked out and doesn't want to know anything, well, conscious sedation is not an optimal choice for you.
2. You may end up getting general anesthesia anyway. Everyone deals with conscious sedation differently. Some people do great with just a little bit of IV sedative and some local anesthetic in their incision. Others get uncomfortable - real uncomfortable. It's uncommon but possible that if you get too uncomfortable during your sedation, the anesthesiologist may have to put you to sleep anyway, defeating the whole purpose of having sedation.
3. Sedative-induced confessions. Yeah, this is a rare sort of thing, but there are some people, when given a small amount of sedative, start confessing like a sentimental college kid on graduation night. People know their tendencies. I know OR personnel I work with who have chosen to have their surgeries at outside hospitals just because they feared what they might say once they had a little sedation.
4. It can actually be more dangerous. This is especially true if you have issues with snoring or sleep apnea. When you are under general anesthesia, you have a breathing tube in your mouth that the anesthesiologist uses to help with your breathing. With conscious sedation, you have small plastic prongs in your nose that give oxygen, but that's about it. When people get sleepy, it is easier for the tissues in their mouth and throat to collapse, blocking the flow of oxygen into the lungs and causing blood oxygen levels to decrease dangerously. The vigilant anesthesia provider, of course, can deal with this accordingly, but even small lapses in vigilance can cause big, big problems. This leads me to the next point...
5. The quality of your conscious sedation experience is very anesthesiologist dependent. If you have an anesthesiologist or nurse anesthetist who is experienced with conscious sedation, and is working with a surgeon who is well aware of the issues faced by the anesthesiologist, things usually go very smoothly. But the problem is with anesthesia providers, like residents, who fail to understand a lot of the complexities that come with giving conscious sedation. I remember being a resident and thinking these cases would be easy; if anything, they are harder than general anesthesics, just for the fact that the patient is partially awake. These conscious sedation cases require, in many ways, more vigilance than general anesthetics.
Ultimately, whether you get general anesthesia or conscious sedation for your surgery depends on several things, including the type of surgery, and the experience/comfort of both your anesthesiologist and surgeon. Most importantly, there needs to be a three-way dialogue, between patient, surgeon, and anesthesiologist in order to arrive at a consensus of the best way to proceed.
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