(1) Local Anesthesia. The administration of
an agent which produces a localized and reversible loss of sensation in a
circumscribed portion of the body.
(2) Minimal Sedation (anxiolysis). A
drug-induced state during which patients respond normally to verbal commands.
Although cognitive function and coordination may be impaired, ventilatory and
cardiovascular functions are unaffected.
(3) Moderate Sedation/Analgesia ("Conscious
Sedation"). A drug-induced depression of consciousness during which a patient
responds purposefully to verbal commands, either alone or accompanied by light
tactile stimulation. Reflex withdrawal from painful stimulation is
NOT considered a purposeful response. No interventions are
required to maintain a patent airway, and spontaneous ventilation is adequate.
Cardiovascular function is usually maintained.
(4) Deep Sedation/Analgesia. A drug-induced
depression of consciousness during which patients cannot be easily aroused but
respond purposefully following repeated or painful stimulation. Reflex
withdrawal from painful stimulation is NOT considered a purposeful
response. 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 function is usually
maintained.
(5) General Anesthesia.
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.
(6) Regional Anesthesia ("Major conduction
blockade") is considered in the same category as General Anesthesia.5
(7) 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.
Authors: Alabama Board of Medical Examiners
ad hoc Committee: Arthur F. Toole, III, M.D.; Jorge A. Alsip,
M.D.; James G. Chambers, III, M.D.; Craig H. Christopher, M.D.; Alcus Ray
Hudson, M.D.; Pamela D. Varner, M.D.; James E. West, M.D.; and Task Force
Sub-Committee: Jeff Plagenhoef, M.D.; Eric Crum, M.D.; Dan J. Coyle, Jr., M.D.;
Gary Monheit, M.D.; Robert Hurlbutt, IV, M.D.; C. Paul Perry, M.D.; W. Guinn
Paulk, M.D.; Mark McIlwain, D.M.D., M.D.; Jerald Clanton, D.M.D., M.D.; Patrick
J. Budny, M.D.; James W. Northington, M.D.; David Franco, M.D.; Thomas E.
Moody, M.D.
