Consent
All departments should have written patient information about sedation.
You should gain informed consent where appropriate, including in your discussion potential risks vs benefits, side effects and alternative options. Explaining sedation in terms they can understand is good practice (table 7). However, you will need to act in the patient’s best interest where pain and/or anxiety is excessive, or similarly where altered mental status means the patient lacks capacity. Written consent, though conventional, is not statutory and in the latter scenarios is of questionable validity. Clear documentation of the process followed in some form in the patient’s notes is essential however.
Table 7: Levels of sedation in patient terms (adapted from the fifth National Audit Project4)
| What will this feel like? | What will I remember? | What’s the risk related to the sedation drugs? | |
| Not sedated; awake | I am awake, possibly anxious. There may be some mild discomfort (depending on the what I am having done) | Everything | Nearly zero |
| Minimal sedation | I am awake and calm. There may be some mild or brief discomfort | Probably everything | Very low risk |
| Moderate sedation | I am sleepy and calm but remain in control. I may feel some mild discomfort | I might remember some things | Low risk |
| Dissociative sedation | I am in a trance. I will not be in control. Any pain or sensations I feel may feel oddly remote, as if I am floating away from my body | I may remember being in a trance or may recall vivid dreams | I will need oxygen and special monitoring. I have a 1 in 10 chance of being sick |
| Deep sedation | I am asleep. I will not be in control | Probably very little | Higher risk. My breathing may slow when I am asleep—and I may need help to breathe—a tube might be inserted into my nose,mouth or (rarely) windpipe. I will need oxygen and special monitoring |
| Anaesthesia | I am deeply ‘asleep’ and unable to respond | Very unlikely to remember anything | Higher risk (but the presence of an anaesthetist increases safety). My breathing may slow or stop and my blood pressure and heart rate may fall. I will need a specialist doctor to look after my breathing and support my blood pressure and heart rate I will need oxygen and special monitoring and equipment |