Twilight Sedation vs. Deep Sedation

May 22, 2012 - PRLog -- Monitored Anesthesia Care commonly referred  by doctors as “MAC”, is a technique that utilizes intravenous sedation. It is also known as twilight sedation. Deep sedation, commonly referred to as “general anesthesia”, on the other hand, is a more invasive anesthesia technique that requires the patient to be hooked up to a lung machine for the duration of the surgery. Being hooked up to the lung machine or not is one of the key differences between twilight sedation vs. deep sedation.  The lung machine is invasive, requires a long tube to be inserted into the throat to deliver the oxygen directly to the lung. The patient is paralyzed during which means that the muscles of breathing are also paralyzed requiring a mechanical ventilation by a lung machine.  None of this occurs in twilight sedation however. Patient is breathing on his own and there is no tube down the throat, and there is no paralysis of the body.    

When it comes to considering the options for sedation, it would be wrong to think that just because general anesthesia is a deeper type of sedation that it is more effective in pain relief. To the contrary, both general anesthesia and twilight sedation equally erase memory and they both equally eliminate pain during the surgical procedure.  The memory loss is limited but yet a very important part of sedation because  often it has been found that it is traumatic for patients to hear conversations, or the ordinary sounds of instruments while they are laying on the operating room table.  The medication used in both general anesthesia and twilight sedation for memory loss eliminates the ability to deposit memory about the surroundings such that all noise, conversation and events are erased  while the surgery is being performed.  
 
While not all surgical procedures can be performed under twilight sedation, essentially all cosmetic procedures can be performed under twilight sedation without need for the more invasive deep sedation.    

So, the question becomes  if patients are in deep sleep in both types of sedation,  and have no pain or memory, in both types of sedation,  why choose one over the other? One significant advantage of twilight sedation is that the systemic risks to the body are minimal. Scientific evidence has overwhelmingly proven that it is always the anesthesia, not the actual surgical procedure, that poses the greatest risk to life.  Some of these grave dangers in deep sedation come from the use of gases.  Gases, such nitric oxide are not used in twilight sedation, but they are in general anesthesia. Nitric Oxide in the body causes vessels to get larger, wider which increases the bleeding potential post-surgically.  Medications which paralyze the entire body musculature are also used in deep sedation while they are never used in twilight sedation. Paralytic medications constrict blood vessels and especially the blood vessels that supply the heart and this increases the potential for heart attacks for patients both while they are on the operating room table and afterwards post-operatively.

Considering, therefore, that the memory loss and the elimination of pain is equally effective in both types of sedation, but that deep sedation has the greater risks to the heart and the vessels, it is not difficult at all to reach to the conclusion that twilight sedation is the way to go, whenever one can go that way, and one can always go that way in cosmetic surgery.