Avoiding conscious sedation

Learn all about the alternatives to conscious sedation, such as nerve blocks and joint injections.

Peter Croft, MD
Peter Croft, MD
5th Aug 2018 • 3m read

Procedural sedations are usually relied upon as a standard part of care—but this isn't always necessary. In this video, from our Ultrasound-Guided Nerve Block Masterclass, you'll learn about the use of alternatives to conscious sedation, such as nerve blocks and joint injections, that can help you to avoid potentially harmful medications, while simultaneously saving time and resources.

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Video Transcript

[00:00:00] For right or wrong, there are many instances where procedural sedation is relied upon as the standard of care. Shoulder dislocations, wrist injuries that need reduction, ankle dislocations, arm and leg injuries that also may require reduction, significant abscess drainage, these are just a few of the procedures that in the past we have handled with varying levels of conscious sedation

[00:00:30] or in some cases, general anesthesia. Conscious sedation occasionally is your only option. Hip dislocation reduction, for instance, remains a procedure that is fraught with difficulty when only using local or regional anesthesia. That being said, many other routine daily procedures can be handled without conscious sedation with a simple understanding of anesthetics, anatomy, and

[00:01:00] ultrasound-guided regional anesthesia techniques. The cost of conscious sedation can be seen at many levels. Priority one is your patient. Sedation is not without risk. Hypoxia, allergy, apnea, and even respiratory or circulatory arrest do occur. Post sedation delirium and agitation are real complications. These are just a few. By definition,

[00:01:30] conscious sedation places risk on your patients. As I have mentioned, sometimes it is imperative to incur these risks, however, if there is another option where you could avoid these risks, your patients will undoubtedly benefit. As many of you already know, a well-done conscious sedation takes significant preparation. One needs to mobilize equipment, nursing staff, and often a change in patient location, for instance to

[00:02:00] the critical care bay that is equipped with more advanced monitoring systems. This can take a significant amount of time, especially in your environment where time is gold. Your patient will be in your department for a much longer duration of time as they are prepared for, go through, and wake up from their sedation. And don't forget about extensive documentation. This is required of you as well as all of your nursing

[00:02:30] staff. Lastly, on a macro scale, there is the financial impact of a conscious sedation. From an insurance and hospital perspective, these procedures bill out at an exceedingly high rate. Your patients will have to absorb this cost, which is often unnecessary as you have an alternative option. And also think about yourself, avoiding conscious sedations will allow you more time with

[00:03:00] your patients, improve workflow, and require much less documentation. It will also likely cause you less stress as there is less risk involved. So, there you have it. Once you have successfully avoided a time-consuming conscious sedation, by orchestrating an ultrasound-guided regional anesthesia procedure, you will begin to actively look for patient scenarios

[00:03:30] in which this can be duplicated. Knowing that you are providing a service to your patient that is special and safe is a very empowering feeling, one that will give you joy in your practice and challenge you to look for new ways to solve problems.