Sedation during regional anesthesia: less is more

Excerpt

Regional anesthesia (RA) provides numerous benefits to patients throughout the perioperative period, including improved comfort and satisfaction with pain control, less nausea and vomiting, and expeditious recovery and discharge. Intraoperative sedation during surgery under RA plays a central role in facilitating patient comfort and anxiolysis. Compared with deep sedation or general anesthesia, light to moderate sedation results in faster cognitive recovery and has been shown to confer a reduced risk of postoperative neurocognitive dysfunction and mortality.^1,2 To promote the goal of reducing these risks, the Fifth International Perioperative Neurotoxicity Working Group consensus statement on “Best Practices for Postoperative Brain Health” recommends titration of anesthetic medications to the lowest required doses using age-adjusted minimum alveolar concentration- and electroencephalography-based anesthesia management in older adults.³ With the high stakes of cognition and mortality on the line, efforts to find optimal sedation techniques to maximize benefit while minimizing risk are understandably in no short supply. …