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Risks of Twilight Anesthesia

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Authored by Lee Wright in Health Care
Published on 09-30-2009

As any doctor will tell you there is an inherent risk in undergoing many medical procedures. The same can be said for receiving any type of anesthesia. Whether anesthesia takes the form of local, regional, twilight, or general anesthesia, all procedures carry some risk. Twilight or sedation anesthesia gets its name from the fact that the patient is in a twilight state, not fully awake, but not unconscious either. This anesthetic technique is becoming more and more popular, particularly as more outpatient surgical procedures move from hospitals and surgical centers to doctor’s offices. The most common risks of twilight anesthesia stem from adverse drug reactions and improper training in administering anesthesia.

The types of drugs used for twilight anesthesia are the same as those used in general anesthesia. They are just administered in smaller doses. Some people prove sensitive to these drugs or may have an adverse reaction due to another drug they are taking. Adverse reactions can range from nausea and vomiting to dizziness and difficulty breathing to anaphylactic shock and death. Since a surgical procedure is typically the first time a patient will encounter the use of these anesthetic drugs, acute adverse reactions are not uncommon. In addition, some of the most common anesthetic agents can adversely react with some common over the counter supplements such as ginseng and echinacea or with some prescription drugs such as MAO inhibitors. In addition, certain medical conditions such as cardiac or pulmonary problems or the fact that the patient is a smoker or obese may require special handling of the anesthetic agents and closer monitoring of the patient.

The combination of any or all of these factors makes even twilight sedation a risky prospect. Because these procedures are migrating to doctor’s offices and away from hospitals and surgical centers, staff administering anesthesia may be under-qualified to deal with any problems that may arise during a procedure. A trained anesthesiologist, required during surgery in hospitals, is a doctor with a medical degree and several years of specialized training. He or she will take a detailed medical history, including all prescription and over the counter medications, vitamins and supplements. An anesthesiologist present in a surgical suite at a hospital is fully trained to monitor a patient and react to any adverse effects and has a full compliment of life-saving equipment available if there is a problem.

Procedures performed in doctor’s offices, in contrast, may lack a thorough medical history interview, the proper consideration of all medications and supplements, and an understanding of any underlying complicating conditions. In addition, if a patient shows signs of distress, staff in doctor’s offices may lack both the life-saving equipment and the training to prevent a tragedy. This can be especially true for children and elderly patients both of whom can present special challenges when attempting proper anesthesia or life-saving techniques. Proper training to administer twilight anesthesia and monitor a patient during a procedure requires the skill to administer the correct doses of a variety of medications, interpretation of information from monitoring devices, and an understanding of when and how to intervene to save a life.

Any form of anesthesia can be dangerous if the medical staff does not take the proper care and have the necessary training to deal with potential problems. The risks of twilight anesthesia, as with any anesthesia procedure, can range from a minor symptom such as dizziness to serious symptoms such as cardiac arrest. Proper training and the presence of life-saving equipment should therefore be prerequisites before the administration of anesthetic agents.

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