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Can you imagine having surgery and feeling all of the pain that comes with it?
Conquering pain is one of the very few breakthroughs and triumphs in medicine that has
potentially affected every human being in the world. There has been many attempts, such as in
600 BCE when India's Sushruta used cannabis vapors to sedate surgical patients and in 400 BCE
Assyrians used carotid compression to produce brief unconsciousness. While these methods were
all makeshift and short-lived, 1846 was the year that one of mankinds greatest fears, the pain of
surgery, was truly eliminated. On October 16, 1846 William T. G. Morton was the first in the
world to publicly and successfully demonstrate the use of ether anesthesia for surgery to remove
a neck tumor (History of Anesthesia). As years pass and the advancement of technology
occurred, the development of anesthesia had also progressed and made possible intricate
operations like organ transplantation and open-heart surgery. These medical procedures as well
as other medical tests would otherwise be impossible to perform if not carried out routinely with
the use of anesthesia (E. Lemer & B. Lemer). General anesthesia has many purposes including
relaxing the muscles of the body, pain relief, blocking memory of the procedure, and inhibiting
normal body reflexes to make surgery safe and easier to perform. With the onset of the
information age, almost everything involving medicine had changed. There are improved safety
standards as well as equipment used to deliver the drugs and monitor vital signs such as blood
pressure, heart rate, and brain activity during surgery. Less than 20 years ago, Desflurane and
Sevoflurane were clinically introduced as inhalation anesthetics. The study of evidence based
medicine had modernized and newer fields of genetics, imaging radiology and even stem cells
becomes quickly integrated into mainstream medicine, and an excellent future for anesthesia is a
valid prediction. Although the world will progress and to further evolve anesthesia, there are still
a few unanswered questions. One question is which form of anesthesia, conscious sedation,

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otherwise known as twilight sedation, or unconscious sedation is overall safer and better for
patients in short procedures.
Although anesthesia undoubtedly induces unresponsiveness and amnesia, the extent
to which it causes unconsciousness is harder to establish. Alkire explained that the mechanism of
anesthesia involves certain anesthetic drugs acting on areas near the midline and abolishing
behavioral responsiveness, but not necessarily consciousness. Consciousness vanishes when
anesthetics produce functional disconnection which interrupts the cortical communication and
causing a loss of integration or when they lead to semi-stable, stereotypic responses, causing
a loss of information capacity. Put simply, when a complex of brain regions in the posterior
parietal area is inactivated, consciousness vanishes. Unconscious sedation is a controlled state of
anesthesia, characterized by partial or complete loss of nerve reflexes, including the ability to
respond to commands and breathe independently. The patient is unable to cooperate, has a
prolonged recovery room convalescence, and higher risk of anesthetic complications. For
patients who have deep surgical phobias, total unconsciousness allows these patients to receive
the treatment they need in a comfortable and relaxed state. Also, according to Mandava, patients
will have no memory of the procedure and it is easier for anesthesiologists to administer the drug
at an accurate and precise level because of advancements in technology. While unconscious
sedation can be used in a wide range of cases because it is the deepest state of sleep about
depending on the type of case, conscious sedation may be better.
Conscious sedation or twilight sedation, is the administration of a mild dose of general
anesthesia through intravenous medications to reduce pain, lessen anxiety and facilitate
relaxation during unpleasant situations or procedures. This type of sedation leads to a state where

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the patients respiratory, reflex, and cardiac functions remain unchanged. Patients are also
capable of providing rational responses as per the doctors requests and questions. Conscious
sedation can be administered anywhere from minor plastic surgeries to dental work, and
procedures that do not require extensive operations or long durations. In many ways, it is better
than unconscious sedation because it does not require highly specialized equipment and even
anesthesia providers sometimes. Patients also have a shorter recovery room recuperation time
since most drugs used for conscious sedation clear their system within an hour or two, allowing
the patient to go home but not to drive himself (Wechter). Conscious sedation will often cause
fewer side effects than unconscious sedation such as less nausea, headaches, muscle pains, and
vomiting when compared. This type of sedation has less of a risk of developing drug-induced
complications such as a threat to cardiovascular and respiratory function. Also, patients generally
endure conscious sedation with less physical discomfort and anxiety about and during the
procedure. Conscious sedation is a relatively safe and cost-effective means to provide sedation or
analgesia to patients undergoing modern therapeutic and diagnostic procedures.
Although some might say conscious sedation seems ideal compared to unconscious
sedation, these positive effects don't come without potential risks. Studies show that conscious
sedation can progress to deep sedation, which causes patients to lose their airway reflexes, to be
unable to follow commands, or experience unstable cardiovascular and respiratory function.
Although this can be a risk in both unconscious and conscious sedation, deep sedation should
only be administered by anesthesiologists of nurse anesthetists, not regular surgeons who mostly
administer conscious sedation. They are not trained or equipped to handle deep sedation
situations and this time loss can be detrimental to the patient. Sedation is a meticulously thought
out process and when something goes wrong, the person administering the drug should be able to

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respond quickly and if that does not occur, who knows what will happen? Sedation is tailored to
the individual, yet it is not possible to judge how each individual patient will respond at all times.
For example, Parker argued that you can sometimes say the elderly will need less anesthesia
because you tend to handle drugs differently as you get older because you tend to have decreased
metabolism and certain drugs' effects get magnified (as cited in Gerasimo). But his use of the
word sometimes demonstrates that the claim is not definite. There is another risk associated
with conscious sedation known as intraoperative awareness. It is defines as the explicit and
unexpected recall by patients of events that occurred during anesthesia, patient may even
experience pain which is usually severe. Awareness results in part from the inability to accurately
measure the depth of anesthesia. Orser, Mazer and Baker state that the dose of anesthetic is best
adjusted by an experienced anesthesiologist, who relies on a multitude of parameters to judge the
degree of anesthesia, including patterns in heart rate, blood pressure, lacrimation and
movement. Again, this statement reiterates the point that anesthesiologists are the best equipped
and trained to handle all sedation situations, a dental surgeon is not. Also, according to a U.S.
News Health survey, 78 percent of 93 patients responded saying that they preferred total sedation
when undergoing a colonoscopy surgery. 80 percent said that they would be more likely to have
a colonoscopy for routine cancer screening if knew they'd be completely asleep during the
procedure. These figures demonstrate that unconscious sedation is more likely preferred
compared to conscious sedation.
While a higher dose of drugs administered with general anesthesia, resulting in
unconscious sedation, are associated with higher risks, conscious sedation has many of the same
risks. But, unconscious sedation is usually administered by an anesthesiologist who is an adept in
providing anesthesia. He would be more aware of the dangers as well as solutions to these

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dangers than a regular doctor. If someone were to fall into a deep sleep from conscious sedation,
who would you trust? Also, why would anyone want to experience any type of pain during the
surgery, the traumatic thought of that gives people chills. Hopefully one day in the future,
technology will advance enough to have no harmful side effects for surgery. Perhaps a new drug
with step into the scene and change anesthesia as we know it. Or maybe a new device will be
invented to compensate for the problems that a consciously or unconsciously sedated patient
would have. But for now, just be grateful for how far we have come in history regarding
anesthesia. Patients had gone from experiencing full-scale pain during surgeries to not feeling an
ounce.

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Work Cited
Alkire, Michael T., Anthony G. Hudentz, and Giulio Tononi. "Consciousness and Anesthesia."
Science Magazine 7 Nov. 2008: n. pag. Print.
Andrews, Michelle. "Would You Rather Be out for Your Colonoscopy?" U.S. News & World
Report: Health 21 Oct. 2008: n. pag. Print.
"Anesthetic Awareness Fact Sheet." American Association of Nurse Anesthetists.
American Association of Nurse Anesthetists, n.d. Web. 9 Jan. 2016.
Geracimos, Ann. "Alert Anesthesia: Patients Have No Memory of Surgery." World and I: n. pag.
Print. "History of Anesthesia." Wood Library-Museum of Anesthesiology. N.p., n.d. Web.
9 Jan. 2016. <http://www.woodlibrarymuseum.org/>.
Lemer, Ed K., and Brenda Wilmoth Lemer. "Anesthesia." Gale Encyclopedia of Science 1
(2008): 210-14. Print.
Mandava, Srinivas, Dr. Personal interview. N.d.
Orser, Beverley A., David Mazer, and Andrew J. Baker. "Awareness during Anesthesia." CMAJ:
Canadian Medical Association Journal: 185-88. Print.
Wechter, Debra G., M.D. "Conscious Sedation for Surgical Procedures." A.D.A.M. Medical
Encyclopedia. N.p.: n.p., n.d. N. pag. Print.