DO YOU HAVE QUESTIONS ABOUT SEDATION?
MAY I CONTINUE TO DRINK HERBAL MEDICATIONS?
Many of the commercially ‘innocent’ herbal drugs have sedative implications and some even affect the clotting of blood.
Two of those drugs need special attention:
- ST JOHN’S WORT:
This drug has an action similar to an older type of antidepressant and should be stopped at least one week before your procedure. This is very important!
This drug is a blood thinner that can lead to haemorrhage (bleeding) into the wound and should be stopped one week before surgery. Should you have any doubts, please contact your surgeon to refer you to the sedationist.
WHAT ABOUT MY ROUTINE MEDICATION?
The following are only guidelines if you take:
- BLOOD PRESSURE MEDICATION: If your surgery is performed in the afternoon, take all your routine medication the morning of surgery. In the case of surgery scheduled for early morning, consult with your sedation practitioner.
- ASTHMA MEDICATION: Continue with treatment and bring your inhalers along.
- MEDICATION FOR DIABETES: For surgery scheduled in the afternoon, take your morning medication and have something to eat, all within the fasting guidelines. You will be fasting from the previous evening for early morning surgery, so DO NOT TAKE YOUR DIABETES MEDICATION OR INJECTION, as you will not be allowed to eat before surgery.
WILL I BE AWARE OF MY SURROUNDINGS DURING MY SEDATION?
Yes, for light sedation, but much less so for procedural sedation and not at all during deep sedation. During light sedation, the way your sedation practitioner verifies your sedation level is to either talk to you or give you a little tap on the shoulder, to which you must respond appropriately. You, therefore, must be awake enough to respond. If you do not respond, your level of sedation is more profound, and the level thereof can be adjusted. Therefore, you must be aware of your surroundings during light sedation.
HOW WILL SEDATION BE ADMINISTERED?
Sedation can be administered orally, by inhalation, intravenously or a combination of these. The oral way of sedation comprises a tablet/syrup administered before a procedure. Inhalation sedation is the administration of Nitrous Oxide (laughing gas) for dental treatment. Intravenous sedation is administered intravenously and, unfortunately, includes the placement of an intravenous cannula (drip).
IS LOSS OF MEMORY FOR THE PERIOD OF SEDATION COMMON AND LASTING?
YES. One of the drugs used to reduce stress levels during sedation is known to cause amnesia or temporary memory loss. It is nothing to be concerned about and, more often than not, a positive for the patient who does not want to remember the procedure. We often get asked by patients to make the sedation a little deeper just so that they can “sleep” and not be aware of the procedure. It is not always possible or safe to grant that request but know that we will control your pain and make you comfortable.
HOW LONG DO I HAVE TO BE STARVED?
As one of the complications of sedation is the unintentional loss of consciousness, you must be prepared as if you will be anaesthetized. Therefore, please liaise with your surgeon or sedation practitioner about your fasting requirements.
The rule of thumb is as follows, but please make sure from your doctor what the specific requirements are for your procedure:
- SOLID FOODS and FLUIDS (all except water and apple juice): 6 hours
- WATER and CLEAR APPLE JUICE: 3 hours
ARE THERE ANY COMPLICATIONS THAT I SHOULD BE AWARE OF?
As with all medical and dental treatment, there is always a risk. Risks may arise from your underlying medical condition/s, body habitus, recreational habits and allergy to some of the medications you use. The most significant danger is deeper than the needed level of sedation or even anaesthesia, but sedation practitioners have been trained to manage that. Other problems can be cold, double vision and headache, which generally subside after a night’s rest. Post-sedation nausea and vomiting occur in less than 1% of patients. More serious adverse event are possible but rarely occur.
WHEN MAY I DRIVE MY CAR AGAIN?
You should not drive a motorized vehicle, work with power tools, or enter into any legal contracts before the following day.
WHEN WILL I BE DISCHARGED?
Your discharge is according to a discharge scoring system used in sedation clinics. You will only be discharged in the care of a responsible adult person after contact details have been provided and the discharge guidelines agreed to.
IS THE BILL FOR MY SEDATION INCLUDED IN THE ACCOUNT FROM THE CLINIC/SURGEON?
No. All the sedation practitioners are independent, and you will receive a separate account for the sedation service. Please consult with the sedation practitioner regarding the detail.
WHAT HAPPENS IF I AM ALLERGIC TO THE DRUGS ADMINISTERED
Some people may think they “are allergic to anaesthetics” because of previous unpleasant experiences such as nausea and vomiting. These are side effects, not allergies. True allergies include mouth, throat or eye swelling, breathing problems, hives and wheals, and sometimes blood pressure drops. These have happened and are well known in medicine, and your sedation practitioner has been trained to treat them properly. If you have a known allergy, there, fortunately, is a range of alternatives, and it is not common to have a case cancelled because of an allergy.
A patient can show allergic reactions to some drugs, but this seldom happens. If it does happen, it is rarely permanent because anaesthesiologists are specialists who will notice these reactions immediately and act fast to prevent any permanent damage. Latex allergy is an increasing phenomenon but seldom severe.
If you suspect such an allergy, you should inform your surgeon and anaesthesiologist to avoid using rubber products. If any allergies occur, your condition will be assessed after the operation so that those products can be avoided in future. You may have to wear a “medic-alert” bracelet. Allergic reactions to one type of anaesthetic do not mean that you will not be able to receive anaesthetics in future.
WILL I NEED A BLOOD TRANSFUSION?
Blood transfusions are uncommon because of the type of surgeries undertaken under sedation.
There are many factors determining the need for a blood transfusion. The most important is the type of operation you will be undergoing and the condition of your own blood before the process. During some procedures, blood loss is unavoidable, regardless of the surgeon’s skills. Therefore, most blood transfusions are given directly after or just before an operation. All fluids given in the operating theatre are administered by the anaesthesiologist. Blood is only issued when the risk of not giving blood exceeds the risk of showing it. Anaesthesiologists are specialists in the field of making these decisions.
WHAT HAPPENS AFTER THE PROCEDURE?
Most patients wake up relatively quickly after the treatment is completed and the medications are stopped. You may experience side effects such as mild headaches, nausea, drowsiness, or even feeling cold, but these are less common than with general anaesthesia. You will also likely recover faster and be able to return home sooner, much sooner than would be the case after anaesthesia.
IV sedation and analgesics are sometimes used with other pain-controlling techniques, such as regional or local anaesthesia. Local anaesthesia numbs a small area of the body with one or more injections, whereas regional anaesthesia numbs a larger portion of the body, such as from the waist down. Therefore, regional anaesthesia is frequently used with IV sedation and analgesics. A typical example is a Total Hip/Knee Replacement under regional anaesthesia with sedation.