WordNet

a state of reduced excitement or anxiety that is induced by the administrative of a sedative agent
the administration of a sedative agent or drug (同)drugging
sink to a lower level or form a depression; "the valleys subside"
wear off or die down; "The pain subsided" (同)lessen
sink down or precipitate; "the mud subsides when the waters become calm" (同)settle
characterized by dignity and propriety (同)staid
cause to be calm or quiet as by administering a sedative to; "The patient must be sedated before the operation" (同)calm, tranquilize, tranquillize, tranquillise
a drug that reduces excitability and calms a person (同)sedative_drug, depressant, downer

PrepTutorEJDIC

(鎮静剤で)落ち着かせること,鎮静状態
〈洪水などが〉引く;〈建物,土地などが〉沈む,落ちこむ / 量が減る,勢いが弱まる / 《話》ぐったりと腰をおろす,沈みこむ
落ち着いた,もの静かな,穏やかな / (鎮静剤で)〈人〉‘を'落ち着かせる,眠らせる
鎮静効課のある,鎮静[作用]の / 鎮静剤

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/20 16:10:04」(JST)

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Not to be confused with sedition.

Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Drugs which can be used for sedation include propofol, etomidate, ketamine, fentanyl, and midazolam.^[1]

Uses

Sedation is now typically used in procedures such as endoscopy, vasectomy, RSI (Rapid Sequence Intubation), or minor surgery and in dentistry for reconstructive surgery, some cosmetic surgeries, removal of wisdom teeth, or for high-anxiety patients. Sedation methods in dentistry include inhalation sedation (using nitrous oxide), oral sedation, and intravenous (IV) sedation. Inhalation sedation is also sometimes referred to as Relative Analgesia.

Sedation is also used extensively in the intensive care unit so that patients who are being ventilated tolerate having an endotracheal tube in their trachea.

Risks

Airway obstruction, apnea and hypotension are not uncommon during sedation and require the presence of health professionals who are suitably trained to detect and manage these problems.

Levels of sedation

Sedation scales are used in medical situations in conjunction with a medical history in assessing the applicable degree of sedation in patients in order to avoid under-sedation (the patient risks experiencing pain or distress) and over-sedation (the patient risks side effects such as suppression of breathing, which might lead to death). Typically, levels are (i) agitation, (ii) calm, (iii) responsive to voice only, (iv) responsive to tactile stimulation, (v) responsive to painful stimulation only, and (vi) unresponsive to painful stimulation.

Examples of sedation scales include: MSAT (Minnesota Sedation Assessment Tool), UMSS (University of Michigan Sedation Scale), the Ramsay Scale (Ramsay, et al. 1974) and the RASS (Richmond Agitation Sedation Scale).

The American Society of Anesthesiologists defines the continuum of sedation as follows:^[2]

Minimal Sedation - Normal response to verbal stimuli.
Moderate Sedation - Purposeful response to verbal/tactile stimulation. (This is usually referred to as "conscious sedation")
Deep Sedation - Purposeful response to repeated or painful stimulation.
General Anesthesia - Unarousable even with painful stimulus.

In the United Kingdom, deep sedation is considered to be a part of the spectrum of general anesthesia, as opposed to conscious sedation.

Ramsay Sedation Scale

The Ramsay sedation scale is used to assess the level of sedation of a hospitalized patient. It was described by Michael A. E. Ramsay.^[3]

The scale, from 1 to 6, describes a patient as follows:^[4]^[5]

anxious and agitated or restless, or both
co-operative, oriented, and calm
responsive to commands only
exhibiting brisk response to light glabellar tap or loud auditory stimulus
exhibiting a sluggish response to light glabellar tap or loud auditory stimulus
unresponsive

Patient screening

Prior to any oral sedation methods being used on a patient, screening must be done to identify possible health concerns. Before using sedation, doctors try to identify any of the following that may apply:

known drug allergies, and sensitivities,
hypertension
heart defects
kidney
other allergens, such as latex allergy
history of stroke or transient ischemic attack (TIA), (certain oral sedation methods may trigger a TIA)
neuromuscular disorders, (such as muscular dystrophy)
a current list of medications and herbal supplements taken by the patient

A patient with any of these conditions must be evaluated for special procedures to minimize the risk of patient injury due to the sedation method.

In addition to the above mentioned precautions, patients should be interviewed to determine if they have any other condition that may lead to complications while undergoing treatment. Any head, neck, or spinal cord injuries should be noted as well as any diagnosis of osteoporosis.

References

^ Brown, TB.; Lovato, LM.; Parker, D. (Jan 2005). "Procedural sedation in the acute care setting.". Am Fam Physician 71 (1): 85–90. PMID 15663030.
^ "Continuum of Depth of Sedation: Definition of general anesthesia and levels of sedation/analgesia" (pdf). American Society of Anesthesiologists. Approved October 27, 2004, amended October 21, 2009. http://www.asahq.org/For-Healthcare-Professionals/~/media/For%20Members/documents/Standards%20Guidelines%20Stmts/Continuum%20of%20Depth%20of%20Sedation.ashx. Retrieved 2010-11-29.
^ Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974; 2:656–659. free registration required
^ Sedation scales Chinese University of Hong Kong
^ Ramsay's description of the scale

External links

Sedation in the Emergency Room - Article by Steven Conrad, MD
DOCS Education (formerly Dental Organization for Conscious Sedation Education)
IV Sedation and Dentistry
Oral Sedation and Dentistry
Sedation: What to expect
Conscious sedation in dentistry in the UK
Standards in Conscious Sedation for Dentistry

UpToDate Contents

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1. 危篤状態の成人における鎮静鎮痛剤：選択、開始、維持、および離脱 sedative analgesic medications in critically ill adults selection initiation maintenance and withdrawal
2. 小児に対する手術室外での鎮静処置に使用する薬剤の選択 selection of medications for pediatric procedural sedation outside of the operating room
3. 小児に対する手術室外での鎮静処置に使用する薬剤 pharmacologic agents for pediatric procedural sedation outside of the operating room
4. 成人における処置時の鎮静 procedural sedation in adults
5. 危篤状態の成人における鎮静鎮痛剤：特性、投与レジメン、および副作用 sedative analgesic medications in critically ill adults properties dosage regimens and adverse effects

English Journal

Stimulant and sedative effects of alcohol.

Hendler RA, Ramchandani VA, Gilman J, Hommer DW.SourceLaboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda,, MD, 20892, USA.
Current topics in behavioral neurosciences.Curr Top Behav Neurosci.2013;13:489-509.
Alcohol produces both stimulant and sedating effects in humans. These two seemingly opposite effects are central to the understanding of much of the literature on alcohol use and misuse. In this chapter we review studies that describe and attempt to measure various aspects of alcohol's subjective, a
PMID 21560041

AMPAKINE enhancement of social interaction in the BTBR mouse model of autism.

Silverman JL, Oliver CF, Karras MN, Gastrell PT, Crawley JN.SourceLaboratory of Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD 20892-3730, USA. Electronic address: jill.silverman@ucdmc.ucdavis.edu.
Neuropharmacology.Neuropharmacology.2013 Jan;64(1):268-82. doi: 10.1016/j.neuropharm.2012.07.013. Epub 2012 Jul 16.
Autism is a neurodevelopmental disorder in which the first diagnostic symptom is unusual reciprocal social interactions. Approximately half of the children diagnosed with an autism spectrum disorder also have intellectual impairments. General cognitive abilities may be fundamental to many aspects of
PMID 22801296

Alfentanil and patient-controlled propofol sedation - facilitate gynaecological outpatient surgery with increased risk of respiratory events.

Nilsson A, Nilsson L, Ustaal E, Sjöberg F.SourceDepartment of Anesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Acta anaesthesiologica Scandinavica.Acta Anaesthesiol Scand.2012 Oct;56(9):1123-9. doi: 10.1111/j.1399-6576.2012.02749.x. Epub 2012 Aug 17.
BACKGROUND: Widespread use of patient-controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients' safety and ease of use of PCS for gynaecological outpatient procedures.METHODS: In a prospective double-blind study, 165 patients were randomized to use propofol or pr
PMID 22897508