What is drug-induced sleep, how and where is sedation used?

Doctors put him into artificial sleep producer Bari Alibasov, who ended up in the intensive care unit of the Sklifosovsky Research Institute after mistakenly drinking pipe cleaning fluid. On June 7, PR director of Alibasov and the Na-Na group Vadim Gorozhankin told RBC. According to him, this is a necessary recovery procedure, since after a chemical burn and related procedures, the producer’s body needs rest. Gorozhankin noted that Alibasov would be in this state for a day or two. Later, the PR director denied the information spread in the media that Bari Karimovich was connected to a ventilator.

Question and answer What is the condition of Bari Alibasov and what are the doctors going to do?

Indications

Indications for the procedure of artificial coma may include manipulations that require complete absence of movement.

Sedation is used for the following groups of people:

• people who have a low pain threshold, which can interfere with both the doctor and the patient;
• patients with any mental or physical disabilities that do not allow them to correctly follow the doctor’s commands;
• people with increased anxiety about their health;
• children. Eliminate the possibility of the child receiving stress or psychological trauma during complex diagnostic or therapeutic procedures. The child does not clearly understand the motives of the doctor’s actions and cannot interact correctly with the doctor.

The risk of not waking up

You should never worry about falling asleep and not coming out of the state of sedation. A negative attitude is not needed in any business, especially during medical procedures.

When planning medicated sleep, keep in mind that risks are always present. The more complex the procedure, the higher their likelihood. You can minimize the risks by choosing a good clinic where the drugs will be prescribed and the doses will be calculated by an experienced anesthesiologist.

Today, drug-induced sleep has become a safe, clearly controlled procedure that is much easier to tolerate by the patient than general anesthesia. The medical staff is well trained and aware of all the unexpected things that can happen during a narcotic sleep session.

Features of sedation

All stages of sedation are controlled by an anesthesiologist.

To successfully complete the procedure, you must follow the preparation instructions:

• the last meal should be completed 12 hours before the procedure;
• one day before the procedure, you should refrain from drinking alcohol and consuming nicotine-containing substances;
• Before the immersion process, cleanse the intestines with an enema.

Before putting a person into an artificial coma, the doctor collects anamnesis, some diagnostic processes, takes tests for the presence of HIV, HbsAg, HCV, Rw in the body, and provides consultations.

During the conversation, the doctor finds out the presence of factors that suggest increasing the dose of sedative medications.

Such factors include dependence on alcohol, nicotine, substance abuse, prolonged use of psychotropic substances, and mental disorders.

In case of chronic diseases, old age, impaired liver and kidney function, the dose of sedatives is reduced.

After the consultation, the doctor begins the injection, after which the patient falls asleep within a minute. The anesthesiologist must monitor the dynamics of blood flow and hemoglobin levels.

Coming out of sleep lasts about 10 minutes. Within 40 minutes, complete rehabilitation occurs, but on this day it is better to remain calm and not make sudden movements.

Preparation for the procedure

Another undeniable advantage of medicated sleep in dentistry is the absence of serious and complex preparation. First of all, the patient must undergo a consultation with an anesthesiologist, then, in exceptional cases, undergo a series of tests and undergo some examinations to assess his state of health and exclude contraindications.

Recommended, but not mandatory for all studies include:

1. General clinical blood test.
2. Biochemical blood parameters (the renal complex is of utmost importance, in particular the level of creatinine).
3. Coagulogram (test to identify blood clotting problems).
4. Test to detect HIV infection.
5. Tests to detect viral hepatitis B and C.
6. Wasserman reaction (test for syphilitic infection).
7. Electrocardiogram (assessment of the cardiovascular system).

Important! This list of tests is standard for many therapeutic and surgical procedures, and therefore is not considered specific preparation specifically for your medicinal sleep. Based on the initial consultation and examination results, the doctor, together with the anesthesiologist, decides on the type of anesthesia.

No special preparation is required for medicated sleep. You should avoid eating 4-5 hours before going to the dentist, and if possible, limit your drinking. It is not recommended to drink caffeine-containing drinks, including strong tea, the day before treatment. You should avoid alcohol and highly carbonated drinks. As for specific medications that the patient constantly takes, the issue should be discussed in advance with the anesthesiologist. This is especially true for heart medications and psychotropic drugs.

Important! Our clinic has been practicing the Anti-AIDS-Antihepatitis sterilization program for infection control for many years, so tests for RW, HIV, and hepatitis are not mandatory for our patients. We have our own sterilization station and disposable kits. When implementing the requirements of this technology, the clinic works with all patients at the highest level of security, as if everyone has an infection, and does not require blood tests.

Levels of medicated sleep

The level of sedation is adjusted by the anesthesiologist with the dose depending on the goals and individual characteristics.

At the easiest level, communication with the patient is possible. He is conscious, reacts to the words and actions of others, but at the same time, physical sensations and intellectual activity are dulled.

At a deeper level, the subject is dozing, but can also respond to speech and actions.

A deep level of sedation is similar to anesthesia and involves complete immersion of the subject in sleep.

There is no reaction to any stimulation, awakening requires effort, breathing and consciousness may be impaired.

Effect on memory, health

Previously, there was an opinion that drug-induced sleep could affect the patient’s overall health, worsening it, and would also negatively affect memory. However, modern anesthetics do not have such unpleasant effects. They are not able to influence the intellect of the sleeper or dull his memory.

Within forty minutes after receiving the drug, the patient feels:

• drowsiness;
• slowness of reaction;
• coordination problems;
• temporary dulling of attention.

All of the above consequences are reversible, reactions are restored after the drug is removed without additional effort on the part of the doctor or patient.

When planning sedation, a person must understand that in the first hours after waking up he will have to give up:

• complex activities that involve mental stress - the work may not bear the expected fruits;
• control of any transport.

Certain anesthetics can induce hallucinations and unusual dreams. However, the use of such drugs is becoming less common.

Drugs used for sedation

To make the event more comfortable and reduce the risk of unpleasant consequences, the sedative should have the following properties:

• short-term effect - lasts up to 10 minutes;
• absence of long-term depression of consciousness - rehabilitation and return to consciousness occurs in a short time;
• absence or minimal likelihood of negative effects.

Also, the medication is selected depending on the purpose of the upcoming manipulations. For mild coma, midazolam is used.

Propofol is used to place a patient into moderate or deep levels of sedation.

Nitrous oxide, xenon, and sevoflurane are introduced into the body through inhalation. After using nitrous oxide, a person calms down and his muscles become relaxed.

During childbirth, sodium hydroxybutyrate is most often used. Since its composition is similar to substances formed in the body, it is less toxic, promotes the dilation of the cervix, does not have a negative effect on the child and the functioning of the uterus, does not interfere with the baby’s breathing, and has a strong analgesic effect. It is administered intravenously.

Less frequently, doctors resort to the use of barbiturates; they have a depressing effect on the central nervous system. But due to their negative impact on the functioning of the heart, they are trying to find an alternative, safer remedy.

Birth of a child

Medication-induced sleep during childbirth is prescribed only if the woman in labor so desires. To make a positive decision, an obstetrician's opinion will be required. The doctor carries out a general analysis of the situation and the condition of the expectant mother.

Sedation is recommended only for long-term labor. The measure is considered necessary in the presence of severe pain that deprives a woman of strength and impairs consciousness. Exhausting painful contractions do not contribute to the positive course of labor. In addition, in such a situation, the baby may also suffer.

During a light sleep, the expectant mother will easily regain her strength. The medications used have mild anesthetic properties. Painful sensations will not disappear completely, they will be muffled a little, and contractions will occur with the same frequency.

During childbirth, sedation is carried out in several stages:

1. The first stage involves the use of relaxing, pain-reducing compounds. A negative point is the possibility of the drug penetrating the placenta. As a result, the newborn baby may also fall asleep.
2. The second stage is the use of sedation drugs. They have minimal toxicity, are safe, and cannot cause breathing problems in a child.

Most mothers who have been prescribed sedation note an improvement in the labor process.

Areas of use

Sedation has a wide range of areas of distribution in modern medicine. Let's look at some of them.

Gynecology

Indications for putting the patient into an artificial coma may include upcoming painful or manipulation that involves a fixed body position.

Obstetrics. During childbirth, the life of the mother or child may be at risk. Nervous tension, fear, prolonged and too painful contractions can exhaust the woman in labor, and she may not be able to cooperate with the obstetrician. Then you can resort to sedation to give the woman a rest.

Other indications:

• large fruit;
• multiple pregnancy;
• scars on the uterus and cervix;
• polyhydramnios;
• stimulation of labor;
• older women in labor.

Dentistry

Effective before surgical interventions (jaw surgery, tooth extraction, abscess). Indicated for allergic reactions to local anesthesia.

Suitable for people who are afraid of dentists, suffering from epilepsy, with mental disabilities, with a weak vestibular apparatus, with long-term painful treatment early, for children to prevent psychological trauma.

Surgery

Artificial coma is applicable during intensive care procedures and long-term operations.

Relieves pain after surgery and promotes faster recovery. Reduces intracranial pressure in case of head injuries.

Diagnostics

There are a number of extremely disturbing studies of various diseases. For example, colonoscopy, gastroscopy, gastroenteroscopy, sigmoidoscopy, puncture, biopsy and others.

In addition to the discomfort and stress they cause, these activities require a strictly fixed body position.

This also includes magnetic resonance imaging and computed tomography.

Dentistry

Dental treatment is an area in which the euthanasia procedure has received maximum demand. Compared to general anesthesia, which is used in the process of all kinds of manipulations, drug-induced sleep in dentistry provides more benefits and guarantees greater safety.

Sedation is recommended for patients with allergies to local anesthesia when complex, painful procedures are required.

Even considering the fact that innovative technologies are used in dentistry, most visitors are still afraid to sit in the dentist’s chair. Using light sleep, it will be easier to perform all the required manipulations in the patient’s mouth without fear of sudden movements.

All kinds of psychological disorders also become an insurmountable obstacle to the work of a dentist. By putting the patient to sleep, the specialist is able to perform high-quality treatment of all teeth in one visit.

Medication-assisted sleep for children is no less in demand in dentistry. It is recommended for very young children who find it difficult to explain how to behave correctly, as well as for those who are terrified of doctors and their instruments.

Advantages and disadvantages

Advantages:

• mild effect on the nervous system;
• stress prevention;
• operative rehabilitation;
• no addiction to sedatives
• low likelihood of side effects;
• indicated for blood pressure disorders.

Flaws:

• medicated sleep has contraindications: chronic diseases, allergies to medications, epilepsy, the presence of acute infectious diseases, alcohol, drug use;
• Long-term use may lead to disorders in the nervous system.

The use of various medications can be accompanied by unpleasant consequences.

Coma is rarely accompanied by side effects, but some patients may experience dizziness, nausea, vomiting within 40 minutes after waking up, and weakness, drowsiness, poor coordination, and low blood pressure during the day.

These symptoms will soon subside. Sometimes there is an allergy to certain substances or individual intolerance.

With the correct selection of the drug and dosage, the risks of negative effects are practically eliminated, and resuscitation promises to be quick and painless.

Contraindications

In dentistry, medicated sleep is an excellent alternative to outdated methods of pain relief and patient sedation. However, even such a safe and widely used procedure has contraindications. These include:

• A stomach loaded with food (in this case, it is enough to wait a few hours).
• Alcohol or drug intoxication (the interaction of inhaled sedatives with ethanol or narcotic substances can be unpredictable and dangerous).
• Traumatic brain injuries - the approach, in this case, is individual, if we are talking about suffered TBI. Particular care should be taken for injuries less than a year old.
• Exacerbation or decompensation of chronic diseases of the body.
• Recent vaccination in childhood or adulthood (it should be remembered that not only standard calendar, but also periodic vaccinations against influenza, staphylococcus, HPV, hepatitis, and so on are also taken into account).
• Allergic intolerance to drugs used to induce medicinal sleep (to prevent disastrous consequences, the anesthesiologist conducts preliminary drug tolerance tests).
• Severe body weight deficiency in a child (especially for infants).
• Specific problems in the functioning of the cardiovascular system (congenital or acquired heart defects that affect hemodynamics).

Important! All of the above contraindications are relative and can be easily corrected before surgery.

The decision to use or refuse medicated sleep is made on an individual basis. There is only one absolute contraindication to performing this type of anesthesia - myasthenia gravis. This disease is rare and represents severe muscle weakness, affecting not only skeletal structures, but also the smooth muscles of the same bronchi.

Medication-induced sleep as a treatment

For neurosis, hysteria, neurasthenia, depression and other disorders, treatment under sedation is used.

Prolonged interrupted sleep is induced using barbamyl or other sleeping pills. Under the influence of these drugs, a person can sleep for about 18-20 hours. The duration of the course is on average 12 days.

Physiological sleep is also prolonged by using sedatives. Sleep lasts about 10-15 hours. To enhance the effect, aminazine is added. The course lasts on average 12 days.

The use of means for prolonged rest helps to calm, reduce anxiety, and affective tension. During sleep, the patient relaxes, psychological indicators return to normal.

Possible consequences

Any medications can cause an allergic reaction in the body. Even those that are safe. Sedation is accompanied by negative consequences extremely rarely. However, in some cases after it the following is observed:

• vomit;
• feeling of nausea;
• dizziness.

In the presence of chronic diseases, especially when they are exacerbated, the use of such anesthesia is contraindicated. During medicinal sleep, such not very pleasant processes as colonoscopy and gastroscopy are usually performed.

Most doctors agree that before manipulation, the patient should undergo fluorography and a cardiogram, and conduct a general blood test. Thanks to this, it is possible to eliminate all possible risks and ensure that a person does not have problems with the heart or respiratory systems while sleeping.

Normally, after using medicinal sleep, after various procedures and surgical interventions, a person quickly and easily comes to his senses. To minimize all negative consequences, the doctor must know whether the person is taking any medications, whether the woman has an expected or existing pregnancy, or whether she has allergies.

Let's sum it up

Medication-induced sleep is anesthesia using small doses of drugs that allows the patient to be immersed in sedation of varying depths. During the procedure, the sleeping person retains his reflexes, the respiratory, circulatory systems and heart function normally. There is no need to connect to life support devices.

Thanks to minimal doses of anesthetics and the use of modern drugs, there are practically no side effects after waking up.

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Possible complications

The probability of developing complications after an artificially induced coma is quite high, and is determined by its duration. Most often, patients develop:

A significant danger is posed by the gag reflex, as a result of which the contents of the stomach can enter the respiratory tract and cause breathing problems. Sometimes there are difficulties with emptying the bladder, which can provoke its rupture, or the development of peritonitis.

If the patient has a weakened respiratory system, complications such as inflammation, pulmonary edema, and tracheobronchitis are possible after recovery from a coma. It is possible that stenosis, pathological changes in the functioning of the gastrointestinal tract, fistulas in the lining of the esophagus,

Severe complications after emerging from a medically induced coma can first lead to clinical and then biological death of the patient.

Artificial coma - prognosis

Coma is a condition in which brain activity decreases. It occurs as a manifestation of a disease or serious injury. A person in a coma does not react to external stimuli: he does not feel pain, his breathing and cardiac activity slow down, his body temperature decreases, and his muscles completely relax.

In this condition, the patient requires very serious observation and control. Doctors have to maintain adequate ventilation and blood circulation. This is an intermediate state between life and death. A person in a coma is extremely vulnerable. Any mistake in maintaining vital functions can be fatal.

The Glasgow scale is used to assess the degree of coma.

A diagnosis of coma has negative associations. Coma after an accident or as a result of some serious illness usually has a poor prognosis. Its use for medicinal purposes is perceived by doctors with concern. A person is artificially put into deep sleep with the help of drugs, which is why such a coma is called artificial, drug-induced or induced.