Emergency first. If this might be anaphylaxis, use epinephrine and call 911.Thoughts of harming yourself: call or text 988.After surgery: trouble breathing or chest pain, call 911.
General information, not medical advice.Read the full note

Epitope Health teaches what published research and FDA labels say, and how strong that evidence is. It cannot know your situation, and nothing here is a diagnosis, a dose for one person, or a decision about whether a food, medicine or procedure suits one person. Those decisions belong with a licensed clinician who can examine you.

If a reaction is happening now, use epinephrine if it has been prescribed and call 911. If you are thinking about harming yourself, call or text 988, any time.

Epitope Health
Menu
Home / Surgery Ready / Anesthesia

Types of anesthesia and sedation: from light sedation to general anesthesia

How the American Society of Anesthesiologists defines the levels of sedation, what monitored anesthesia care is, and what the research shows about spinal, epidural and nerve block anesthesia.

4 minute read10 sources, each checked word for wordLibrary checked October 18, 2026

In short

  • Sedation is a continuum: from minimal sedation, where people respond normally, to general anesthesia, where they cannot be woken even by pain.E2Good1
  • Under deep sedation and general anesthesia, breathing can be impaired and may need support.E2Good1
  • Serious complications of spinal and epidural anesthesia are rare.E2Good2
  • In older adults having hip fracture surgery, spinal anesthesia was not better than general anesthesia for survival and walking at 60 days.E1Strong3

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades mean

The levels of sedation

The American Society of Anesthesiologists describes sedation and anesthesia as a continuum. Each level is defined by how a person responds and how well they breathe on their own.E2Good1

The ASA continuum, in plain words
LevelWhat the ASA definition says
Minimal sedationPeople respond normally to spoken commands. Thinking and coordination may be impaired, but airway reflexes, breathing and circulation are unaffected.E2Good1
Moderate sedation (conscious sedation)People respond purposefully to spoken commands, alone or with a light touch. No help is needed to keep the airway open, breathing is adequate, and circulation is usually maintained.E2Good4
Deep sedationPeople cannot be easily woken but respond purposefully to repeated or painful stimulation. Breathing on their own may be impaired, and they may need help keeping the airway open.E2Good1
General anesthesiaA drug-induced loss of consciousness in which people cannot be woken, even by painful stimulation. The ability to breathe independently is often impaired.E2Good1

Sedation can become deeper than intended. For this reason, the ASA says whoever gives moderate sedation should be able to rescue a person who slips into deep sedation. Likewise, whoever gives deep sedation should be able to rescue a person who slips into general anesthesia.E2Good4

What is monitored anesthesia care (MAC)?

The ASA explains that monitored anesthesia care is not a level on the continuum. It is a specific anesthesia service performed by a qualified anesthesia provider for a diagnostic or therapeutic procedure.E2Good4

The propofol label lists starting and maintaining MAC sedation in adults among its uses. It says that for general anesthesia or MAC sedation it should be given only by people trained in general anesthesia who are not doing the procedure.Official text5

A study of malpractice claims found that oversedation leading to slowed breathing was an important cause of injury during MAC. It also found that monitoring, vigilance and early resuscitation could have prevented many of these injuries.E2Good6

More than 40% of the MAC claims involved death or permanent brain damage, similar to claims for general anesthesia.E2Good6

Spinal, epidural and nerve block anesthesia

An epidural is a central nerve block: local anesthetic is injected close to the nerves that carry pain.E1Strong7

Spinal and epidural anesthesia together are called neuraxial blockade. An overview of randomized trials found overall deaths about a third lower in patients assigned to neuraxial blockade.E1Strong8

The authors said the size of some of these benefits is uncertain. They said more research is needed to know whether they come from the block itself or partly from avoiding general anesthesia.E1Strong8

In the REGAIN trial of older adults having hip fracture surgery, spinal anesthesia was not superior to general anesthesia for survival and walking at 60 days. Delirium rates were similar.E1Strong3

A UK national audit found serious complications of spinal and epidural anesthesia rare. Permanent injury was estimated at 2.0 to 4.2 per 100,000 cases, and two thirds of initially disabling injuries resolved fully.E2Good2

A review estimated neurological complications after spinal or epidural blocks at under 0.04%. It estimated nerve symptoms after peripheral nerve blocks at under 3%, with permanent injury rare.Review9

Who gives anesthesia?

The propofol label covers who gives it for general anesthesia or MAC sedation. It states it should be given only by people trained in general anesthesia who are not involved in the procedure itself. The sevoflurane label says the same for that gas.Official text5,10

What is not known yet

Whether the benefits seen with neuraxial anesthesia come from the block itself or partly from avoiding general anesthesia is still uncertain.E1Strong8

Questions you might bring to your anesthesia team

  1. What type and depth of anesthesia is planned, and why?
  2. Who will give the anesthesia, and who will watch my breathing throughout?
  3. Is a spinal, epidural or nerve block an option for this procedure?
  4. What are the common side effects and the rare serious risks of the plan?

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.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. American Society of Anesthesiologists, 2024. E2Good Guideline
    The words this page rests on
    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.
    General Anesthesia is 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.
    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.
  2. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Cook TM, Br J Anaesth, 2009. E2Good Observational study
    The words this page rests on
    Serious complications of central neuraxial block (CNB) are rare.
    The incidence of permanent injury due to CNB (expressed per 100,000 cases) was 'pessimistically' 4.2 (95% confidence interval 2.9-6.1) and 'optimistically' 2.0 (1.1-3.3).
    Two-thirds of initially disabling injuries resolved fully. The data are reassuring and suggest that CNB has a low incidence of major complications, many of which resolve within 6 months.
  3. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. Neuman MD, N Engl J Med, 2021. E1Strong Randomized trial
    The words this page rests on
    Spinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia.
  4. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. American Society of Anesthesiologists, 2024. E2Good Guideline
    The words this page rests on
    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.
    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.
    Monitored Anesthesia Care (“MAC”) does not describe the continuum of depth of sedation, rather it describes “a specific anesthesia service performed by a qualified anesthesia provider, for a diagnostic or therapeutic procedure.”
  5. DIPRIVAN (propofol) injectable emulsion, Prescribing Information. Fresenius Kabi USA, LLC, 2025. Official text FDA label
    The words this page rests on
    DIPRIVAN is an intravenous general anesthetic and sedation drug indicated for: (1) • Induction of General Anesthesia for Patients Greater than or Equal to 3 Years of Age • Maintenance of General Anesthesia for Patients Greater than or Equal to 2 Months of Age • Initiation and Maintenance of Monitored Anesthesia Care (MAC) Sedation in Adult Patients • Sedation for Adult Patients in Combination with Regional Anesthesia • Intensive Care Unit (ICU) Sedation of Intubated, Mechanically Ventilated Adult Patients
    For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.
  6. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Bhananker SM, Anesthesiology, 2006. E2Good Observational study
    The words this page rests on
    Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries.
    More than 40% of claims associated with MAC involved death or permanent brain damage, similar to general anesthesia claims.
  7. Epidural versus non-epidural or no analgesia for pain management in labour. Anim-Somuah M, Cochrane Database Syst Rev, 2018. E1Strong Systematic review
    The words this page rests on
    Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour.
  8. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Rodgers A, BMJ, 2000. E1Strong Meta-analysis
    The words this page rests on
    Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio=0.70, 95% confidence interval 0.54 to 0.90, P=0. 006).
    Neuraxial blockade reduces postoperative mortality and other serious complications. The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia.
  9. Neurological complications after regional anesthesia: contemporary estimates of risk. Brull R, Anesth Analg, 2007. Review Expert review
    The words this page rests on
    Our review suggests that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%. The rate of neuropathy after PNB is <3:100, or 3%. However, permanent neurological injury after RA is rare in contemporary anesthetic practice.
  10. ULTANE (sevoflurane) volatile liquid for inhalation, Prescribing Information. AbbVie Inc., 2025. Official text FDA label
    The words this page rests on
    ULTANE is indicated for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgery. ULTANE should be administered only by persons trained in the administration of general anesthesia.