Clinical Updates in Reproductive Health

Appendix: Continuum of depth of sedation: Definition of general anesthesia and levels of sedation/analgesia

Minimal sedation anxiolysis

Responsiveness: Normal response to verbal stimulation

Airway: Unaffected

Spontaneous ventilation: Unaffected

Cardiovascular function: Unaffected

Moderate sedation/analgesia (“conscious sedation”)

Responsiveness: Purposeful * response to verbal or tactile stimulation

Airway: No intervention required

Spontaneous ventilation: Adequate

Cardiovascular function: Usually maintained

Deep sedation/analgesia

Responsiveness: Purposeful * response following repeated or painful stimulation

Airway: Intervention may be required

Spontaneous ventilation: May be inadequate

Cardiovascular function: Usually maintained

General anesthesia

Responsiveness: Unarousable even with painful stimulus

Airway: Intervention often required

Spontaneous ventilation: Frequently inadequate

Cardiovascular function: May be impaired

Minimal sedation (anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes and ventilatory and cardiovascular functions are unaffected.

Moderate sedation/analgesia (“conscious sedation”) is a drug-induced depression of consciousness during which patients respond purposefully* to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Deep sedation/analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully* following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular funcation is usually maintained.

General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue** patients whose level of sedation becomes deeper than initially intended.Individuals administering moderate sedation/analgesia(“conscious sedation”) should be able to rescue** patients who enter a state of deep sedation / analgesia, while those administering deep sedation/analgesia should be able to rescue** patients who enter a state of general anesthesia.

* Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.

** Rescue of a patient from a deeper level of sedation than intended is an intervention by a practitioner proficient in airway management and advanced life support.The qualified practitioner corrects adverse physiologic consequences of the deeper-than-intended level of sedation – such as hypoventilation, hypoxia and hypotension – and returns the patient to the originally intended level of sedation.It is not appropriate to continue the procedure at an unintended level of sedation.

References

American Society of Anesthesiologists. (2018). Position on Monitored Anesthesia Care. Last amended on October 17, 2018.

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