Sedation and regional anesthesia

Sedation is a well recognized technique to improve patients' acceptance and comfort during regional anesthesia. The use of this technique is growing exponentially and is nowadays applied not only in the operating room but also in many other different locations within and outside the hospital.

Different methods of applying sedation are used. Recent studies have shown that the target-controlled infusion technique is advantageous in this context, as the incidence of side effects is lower and the amount of infused drugs is decreased. Several devices have been investigated in this setting, but, to date, none of them has been shown to be reliable. The combination of propofol and remifentanil for the purpose of analgosedation is increasingly used. The benefits of these drugs given simultaneously are supported by several investigations. Dexmedetomidine, the most recently introduced sedative, still needs to be more extensively studied in this context. Nurse-driven sedation will be inevitable in the future. Anesthesiologists should build up guidelines and nurse-teaching programs to fulfill this new development.

The explosion of sedation well beyond the world of regional anesthesia has raised new challenges. Some sedative procedures will be performed more and more often by nonanesthesiologists in the future. This trend is inevitable due to limited resources and stresses on the importance of building up education and teaching programs for nonanesthesiologists. The need for reliable devices for monitoring of sedation and new hypnotics, which have even better phamacokinetics than those available, are needed to match the new issues of sedation.