This is the clinician view. It keeps every sentence of the plain guide and adds, for each section, the study design and citations of its sources. Every added sentence is cited and checked like the rest. Back to plain language.
The levels of sedation
In minimal sedation, people respond normally, and breathing and circulation are unaffected. In moderate sedation, people respond to speech or light touch, and breathing is adequate without help.E2Good1,4
In deep sedation, people cannot be easily woken and may need help keeping the airway open.E2Good4
The ASA says those giving moderate sedation should be able to rescue a person who slips into deep sedation.E2Good1
The evidence in this section (2 sources)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 4 American Society of Anesthesiologists, 2024 | Guideline | E2Good | Not tracked |
|---|
| 1 American Society of Anesthesiologists, 2024 | Guideline | E2Good | Not tracked |
|---|
Sedation for children at the dentist
The American Academy of Pediatrics and the American Academy of Pediatric Dentistry wrote joint guidelines for sedating children for procedures.E2Good2
They call for no sedating medicine without medical or dental supervision and a careful check of conditions that raise risk. They also call for appropriate fasting and an airway exam for large tonsils or other problems.E2Good2
They add airway rescue skills, age- and size-appropriate equipment, and reversal medicines. They call for enough trained staff to both do the procedure and watch the child, and monitoring during and after. They also call for a staffed recovery area, and recovery to usual alertness before going home.E2Good2
The evidence in this section (1 source)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 2 Coté CJ, Pediatrics, 2019 | Guideline | E2Good | Not tracked |
|---|
What the drug labels warn
The midazolam label warns that intravenous midazolam has been linked with slowed and stopped breathing, especially when used for sedation outside critical care.Official text3
It warns that combining benzodiazepines and opioids may cause profound sedation, slowed breathing, coma and death.Official text3
The bupivacaine label lists dental and oral surgery among its uses. It also lists early warning signs of local anesthetic toxicity, including numbness of the mouth and lips, metallic taste, ringing in the ears and dizziness.Official text5
The evidence in this section (2 sources)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 3 Hospira, Inc., 2024 | FDA label | Official text | Not tracked |
|---|
| 5 Hospira, Inc., 2023 | FDA label | Official text | Not tracked |
|---|
Blood thinners and dental work
The chest physicians' guideline has separate recommendations for dental procedures and other minor procedures.E2Good6
The evidence in this section (1 source)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 6 Douketis JD, Chest, 2022 | Guideline | E2Good | 331 (RCR 35.35) |
|---|
Questions you might bring to your anesthesia team
- What level of sedation is planned, and who gives it and watches breathing?
- What training, monitoring and rescue equipment are in place?
- For a child: who stays with my child during recovery, and when can we go home?
- Do I need to stop eating and drinking beforehand?
Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.
Depending on the procedure, the level of sedation may range from minimal (you’ll feel drowsy but able to talk) to deep (you probably won’t remember the procedure). Moderate or deep sedation may slow your breathing, and in some cases, you may be given oxygen.
But even with deep sedation, you won’t be unconscious, as you would be with general anesthesia.
Moderate Sedation/Analgesia (“Conscious Sedation”) is a drug-induced depression of consciousness during which patients respond purposefully** to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.
Deep Sedation/Analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully** following repeated or painful stimulation. 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.
Prevention of regurgitation and aspiration is why all patients are told to fast before any procedure that requires general anesthesia or sedation.
Local anesthesia, also called local anesthetic, is usually a one-time injection of medicine that numbs a small area of the body. It is used for procedures such as performing a skin biopsy or breast biopsy, repairing a broken bone, or stitching a deep cut. You will be awake and alert, and you may feel some pressure, but you won’t feel pain in the area being treated.
