Patients Often Get GA, Not “A Little Sedation”

Lee A. Balaklaw, MD

To the Editor:

I would like to raise a question in the terms of the language that we use with patients when we describe sedation to them. In many instances, sedation is given to the patient but, in fact their protective reflexes and their ability to respond are ablated. I have always described to the patient and family a procedure where the patient was going to be asleep, no matter how briefly, as a general anesthetic. While this issue may be one of semantics, there certainly can be legal ramifications. For example if a patient aspirated while “sedated” under (for example) a propofol infusion anesthetic, the patient might have legal recourse against the anesthesia provider for misleading the patient. In that instance the patient may have been told that they may be having only “sedation” but in fact were given a brief general anesthetic. I would like to know how the APSF Newsletter readers view this issue. I suspect in many instances patients are being misled. Cataract surgery comes to mind because, in many settings propofol was administered for “analgesia” for a retrobulbar block. When we used propofol in our elderly patients, not only were the patients apneic but they were unresponsive for a minute or so. Today we use remifentanil and do not experience the same problems. Therefore we can truly say that the patient is just getting sedation as opposed to a brief general anesthetic. I’m sure there are numerous other procedures such as endoscopy, etc., that probably fall in to the same category. Collectively this practice probably accounts for a significant number of procedures per year. There are significant case reports in the literature of problems in such cases, and certainly aspiration and hypoxia are two of the most prominent problems that come to mind. Are we deceiving the public when we tell them that they are getting “a little sedation” when in fact a brief period of anesthesia is being induced? I would appreciate any comments or thoughts the anesthesia community has in regard to this important and widespread issue.

Lee A. Balaklaw, MD Anesthesia Associates of Louisa, PSC Louisa, Kentucky