Is Procedural Sedation the Same as Moderate Sedation?

Procedural sedation may be minimal, moderate, or deep (general anesthesia). Moderate sedation also referred to as conscious sedation or twilight sedation.

Procedural sedation refers to the process of administering sedatives or dissociative agents with or without pain relievers/blockers (analgesics/anesthetics) to result in lowered consciousness to allow patients to tolerate medical procedures while maintaining breathing and keeping their airway open on their own. Patients are usually relaxed or even drowsy and do not feel pain, but they remain awake and able to respond to verbal instruction. Procedural sedation may be minimal, moderate, or deep (general anesthesia). 

Moderate sedation, also referred to as conscious sedation or twilight sedation, is drug-induced and:

• A patient can still respond to verbal commands
• Breathing is not affected and patients can breathe on their own
• Cardiovascular function is usually unaffected

Procedural sedation differs from general anesthesia, which is a form of a temporary medically induced coma (unconsciousness) in which the airways may be taken over and monitored by a doctor, rather than the patient breathing on their own.

Procedural sedation and moderate sedation are used for procedures such as:

• Dental procedures
  • Cleanings for sensitive individuals
  • Filling cavities
  • Root canal
  • Tooth extraction
  • Dental implants
  • Cleanings in sensitive patients
  • Filling cavities cavity filling
• Medical examinations using a scope
  • Endoscopy
  • Colonoscopy
  • Bronchoscopy
• Minor surgical procedures
  • Vasectomy
  • Biopsies
  • Minor bone fracture surgery
  • Cardiac ablation procedures 
  • Electrical cardioversion
  • Minor skin surgery
• Radiation therapy
• Fix a dislocated joint
• Lumbar puncture 

Risks and side effects of procedural sedation and moderate sedation include:

• Low blood pressure (hypotension)
• Low blood oxygen (hypoxia)
• Slow heart rate
• Irregular heartbeats
• Respiratory depression
• Need for assisted ventilation
• Intubation
• Becoming more deeply sedated than intended
• The procedure may not be effective (not enough anesthesia)
• Allergic reaction
  • Swelling
  • Rash
  • Nausea
  • Vomiting

Most of these risks can be prevented or avoided with:

• Appropriate monitoring
• Preoxygenation
• Appropriate airway management
• Having equipment and resuscitation medications available
• Having reversal agents for opioids or benzodiazepines readily available