Twilight sleep anesthesia

Twilight sleep anesthesia also known as a twilight anesthesia, “I.V. sedation”, “conscious sedation” or “zombie state,” is an anesthetic technique characterized by insensibility to pain without loss of consciousness, induced by an injections of scopolamine–morphine mixture to anesthetize laboring women especially to relieve the pain of childbirth. Twilight sleep anesthesia allows patients to be sedated without completely losing consciousness. During surgery or other medical procedures, the patient is under what is known as a “twilight state”, where the patient is relaxed and “sleepy”, able to follow simple directions by the doctor, and is responsive. Generally, twilight anesthesia causes the patient to forget the surgery and the time right after. It is used for a variety of surgical procedures and for various reasons. Just like regular anesthesia, twilight anesthesia is designed to help a patient feel more comfortable and to minimize pain associated with the procedure being performed and to allow the medical practitioner to practice without interruptions. Twilight sleep anesthesia is safe and effective for people who need minor surgery or a procedure to diagnose a condition.

There are four levels of sedation by anesthesia. Twilight anesthesia is level 2, also known as moderate sedation/analgesia or conscious sedation, a drug induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied with light physical stimulation. Breathing tubes are not required for this type of anesthesia. Some of the same drugs used in general anesthesia are also used for twilight anesthesia, except in smaller doses and in a bolus interval (a concentrated mass of a substance administered intravenously for diagnostic or therapeutic purposes). These drugs can be administered via gases, such as nitrous oxide (laughing gas), or intravenously, with drugs such as ketamine (pediatrics primarily, and infrequently in adults), propofol, and midazolam. Twilight anesthesia alone is not used to provide relief from surgical pain, therefore, it is always given in conjunction with a local or regional anesthetic. Additionally, IV sedation is frequently administered as a concoction of several agents including those previously mentioned for induction and maintenance of anesthesia, as well as a benzodiazepine (usually midazolam, but temazepam or flunitrazepam are also used via the oral route) and a narcotic/systemic analgesic such as demerol or fentanyl. As discussed in the levels of sedation by anesthesia, assistance with breathing tubes (endotracheal tube or laryngeal mask airway) are not generally used for this type of anesthesia.

Patients under twilight anesthesia are carefully maintained in a state of drowsy relaxation during their surgical procedure. It is common for patients to fall into a light sleep during this type of anesthesia. The medication for sedation is delivered intravenously, while the surgeon or anesthesiologist injects the area to be operated on with a local anesthetic (ie. numbing medicine) for pain. It is completely normal for people to remember being in the operating room while under twilight anesthesia, or to remember people talking to them while the procedure is occurring. It is also possible to have vivid dreams, and to recall them after the procedure. These are all normal with twilight anesthesia, yet many people remember nothing at all. You should not feel pain, however, during twilight anesthesia, because the area to be operated on will always be numbed by the surgeon. These numbing medications last anywhere from 1-6 hours.

As with any anesthetic, all of the patient’s vital signs are continuously monitored throughout the procedure, but a breathing tube is not required Conscious Sedation because the patient is responsive enough to continue breathing. The recovery period for twilight anesthesia is usually very brief, and many patients feel better after this type of sedation than with general anesthesia.

Twilight sleep anesthesia uses

Twilight anesthesia is applied to various types of medical procedures and surgeries. It is a popular choice among surgeons and doctors who are performing anything from minor plastic surgeries to dental work, and procedures that do not require extensive operations or long durations in favor of less nausea and a limited recovery period after surgery.

Some of the tests and procedures that twilight sleep anesthesia may be used for are:

• Breast biopsy
• Dental prosthetic or reconstructive surgery
• Minor bone fracture repair
• Minor foot surgery
• Minor skin surgery
• Plastic or reconstructive surgery
• Procedures to diagnose and treat some stomach (upper endoscopy), colon (colonoscopy), lung (bronchoscopy), and bladder (cystoscopy) conditions .

After the procedure

After twilight anesthesia, you will feel sleepy and may have a headache or feel sick to your stomach. During recovery, your finger will be clipped to a special device (pulse oximeter) to check the oxygen levels in your blood. Your blood pressure will be checked with an arm cuff about every 15 minutes.

You should be able to go home 1 to 2 hours after your procedure.

When you are home:

• Eat a healthy meal to restore your energy.
  You should be able to return to your everyday activities the next day.
• Avoid driving, operating machinery, drinking alcohol, and making legal decisions for at least 24 hours.
• Check with your doctor before taking any medicines or herbal supplements.
• If you had surgery, follow your doctor’s instructions for recovery and wound care.

Twilight sleep side effects

Twilight sleep anesthesia is usually safe. However, if you are given too much of the medicine, problems with your breathing may occur. A doctor will be watching you during the whole procedure.

Your doctors always have special equipment to help you with your breathing, if needed. Only certain qualified health professionals can provide twilight sleep anesthesia.

Some common side effects of twilight sleep anesthesia may last for a few hours after the procedure, including:

• drowsiness.
• feelings of heaviness or sluggishness.
• loss of memory of what happened during the procedure (amnesia)
• slow reflexes.
• low blood pressure.
• headache.
• feeling sick.