Conscious sedation helps reduce anxiety, discomfort, and pain during certain procedures. This is accomplished with medications and (sometimes) local anesthesia to induce relaxation.
Conscious sedation is commonly used in dentistry for people who feel anxious or panicked during complex procedures like fillings, root canals, or routine cleanings. It’s also often used during endoscopies and minor surgical procedures to relax patients and minimize discomfort.
Conscious sedation is now usually referred to by medical professionals as procedural sedation and analgesia. In the past, it’s been called:
- sleep dentistry
- twilight sleep
- happy gas
- laughing gas
- happy air
Conscious sedation is known to be effective, but medical professionals still debate its safety and efficacy because of its effects on your breathing and heart rate.
Read on to learn how exactly it works, what it feels like, and how it might be used.
Conscious sedation and general anesthesia differ in several significant ways:
|Conscious sedation||General anesthesia|
|What procedures is this used for?||examples: dental cleaning, cavity filling, endoscopy, colonoscopy, vasectomy, biopsy, minor bone fracture surgery, tissue biopsies||most major surgeries or upon request during minor procedures|
|Will I be awake?||you’re still (mostly) awake||you’re almost always fully unconscious|
|Will I remember the procedure?||you may remember some of the procedure||you should have no memory of the procedure|
|How will I receive the sedative/drugs?||you may receive a pill, inhale gas through a mask, get a shot into a muscle, or receive a sedative through an intravenous (IV) line in your arm||this is almost always given through an IV line in your arm|
|How quickly does it take effect?||it may not take effect immediately unless delivered through an IV||it works a lot faster than conscious sedation because the drugs enter your bloodstream immediately|
|How soon will I recover?||you’ll likely regain control of your physical and mental faculties quickly, so you may be able to take yourself home soon after a conscious sedation procedure||it may take hours to wear off, so you’ll need someone to take you home|
There are also three different stages of conscious sedation:
- Minimal (anxiolysis). You’re relaxed but fully conscious and responsive
- Moderate. You’re sleepy and may lose consciousness, but you’re still somewhat responsive
- Deep. You’ll fall asleep and be mostly unresponsive.
The steps for conscious sedation may differ based on the procedure you’re having done.
Here’s what you can typically expect for a general procedure using conscious sedation:
- You’ll sit in a chair or lie on a table. You may change into a hospital gown if you’re getting a colonoscopy or endoscopy. For an endoscopy, you’ll usually lie on your side.
- You’ll receive a sedative through one of the following: an oral tablet, an IV line, or a facial mask that lets you inhale the sedative.
- You’ll wait until the sedative takes effect. You may wait up to an hour before you begin to feel the effects. IV sedatives usually begin working in a few minutes or less, while oral sedatives metabolize in about 30 to 60 minutes.
- Your doctor monitors your breathing and your blood pressure. If your breathing becomes too shallow, you may need to wear an oxygen mask to keep your breathing consistent and your blood pressure at normal levels.
- Your doctor begins the procedure once the sedative takes effect. Depending on the procedure, you’ll be under sedation for as little as 15 to 30 minutes, or up to several hours for more complex procedures.
You may need to request conscious sedation in order to receive it, especially during dental procedures like fillings, root canals, or crown replacements. That’s because typically, only local numbing agents are used in these cases.
Some procedures, such as colonoscopies, may include conscious sedation without a request, but you can ask for different levels of sedation. Sedation can also be given as an alternative to general anesthesia if your risk of complications from anesthesia is too high.
The drugs used in conscious sedation vary based on delivery method:
- Oral. You’ll swallow a tablet containing a drug like diazepam (Valium) or triazolam (Halcion).
- Intramuscular. You’ll get a shot of benzodiazepine, such as midazolam (Versed), into a muscle, most likely in your upper arm or your butt.
- Intravenous. You’ll receive a line in an arm vein containing a benzodiazepine, such as midazolam (Versed) or Propofol (Diprivan).
- Inhalation. You’ll wear a facial mask to breathe in nitrous oxide.
Sedation effects differ from person to person. The most common feelings are drowsiness and relaxation. Once the sedative takes effect, negative emotions, stress, or anxiety may also gradually disappear.
You may feel a tingling sensation throughout your body, especially in your arms, legs, hands, and feet. This may be accompanied by a heaviness or sluggishness that makes it feel harder to lift or move your limbs.
You may find that the world around you slows down. Your reflexes are delayed, and you may respond or react more slowly to physical stimuli or to conversation. You may even start smiling or laughing without an obvious cause. They call nitrous oxide laughing gas for a reason!
Some common side effects of conscious sedation may last for a few hours after the procedure, including:
- feelings of heaviness or sluggishness
- loss of memory of what happened during the procedure (amnesia)
- slow reflexes
- low blood pressure
- feeling sick
Recovery from conscious sedation is pretty quick.
Here’s what to expect:
- You may need to stay in the procedure or operating room for up to an hour, maybe more. Your doctor or dentist will usually monitor your heart rate, breathing, and blood pressure until they’re back to normal.
- Bring a family member or friend who can drive or take you home. You can usually drive once some forms of sedation, such as nitrous oxide, wear off. However, this isn’t always the case for other forms.
- Some side effects may last for the rest of the day. These include drowsiness, headaches, nausea, and sluggishness.
- Take a day off work and avoid intense physical activity until side effects wear off. This is especially true if you plan to do any manual tasks that require precision or operate heavy machinery.
Conscious sedation costs vary depending on:
- the type of procedure you’re having done
- the type of sedation chosen
- what sedative drugs are used
- how long you’re sedated
Conscious sedation may be covered by your health insurance if it’s considered part of the typical procedure. Endoscopies and colonoscopies often include sedation in their costs.
Some dentists may include sedation in their costs for more complex procedures, such as cosmetic dental work. But many dental plans do not cover conscious sedation if it’s not required by medical regulations.
If you elect to be sedated during a procedure that doesn’t normally include it, the cost may only be covered partially or not covered at all.
Here’s a breakdown of some typical costs:
- inhalation (nitrous oxide): $25 to $100, often between $70 and $75
- light oral sedation: $150 to $500, possibly more, depending on drugs used, how much sedative is needed, and where your healthcare provider is located
- IV sedation: $250 to $900, sometimes more
Conscious sedation is a good option if you feel anxious about a medical or dental procedure.
It’s usually not too costly and has few side effects or complications, especially in comparison to general anesthesia. It may even encourage you to go to important appointments that you’d otherwise put off because you’re nervous about the procedure itself, which can improve your overall health throughout your life.