Cushing en salle d'opération

Why a sedation?

Historically, most analgesic procedures were performed under local anesthesia and it is therefore legitimate to ask the question of the usefulness of sedation.

Benefits:

  • Safety : when sedated, there are fewer vagal reactions, sudden changes in blood pressure and the patient is better controlled. As the procedure is also less stressful for the patient, the risks associated with stress are reduced.

  • Comfort : the procedure takes place peacefully without pain. Patients with chronic pain are more sensitive than others and even something that might seem trivial can be felt in them as very painful.

  • Precision : the patient does not move, the precision of the gesture is facilitated and less trajectories are needed to reach the target. The operator will also be more demanding as to the quality of the target and not be satisfied with an imperfect target.

  • Philosophical : We have always found that treating pain that hurts is a paradox.

  • Hypothetical : numerous studies in animals suggest that memorizing pain is an important point in chronic pain and that sedation could facilitate "resetting the counters to zero". This remains to be demonstrated in humans.

How does sedation work?

The anesthetist administers a sedative (propofol) through a venous line. He may also have relaxed the patient with other drugs in very small doses (fentanyl, midazolam, ...) and / or prepare the vein with a local anesthetic (lidocaine). The patient is not intubated (endotracheal tube) or connected to a ventilation machine as they would be for general anesthesia for a major operation. He is therefore in supervised spontaneous ventilation.
Once the sedation is complete, the patient is monitored in the recovery room both on the cardiovascular and neurological level.

Precautions and monitoring:
  • Oxygenation : oxygen mask at 6 liters per minute

  • Cardiac monitoring with electrodes and ECG scope

  • Respiratory monitoring

  • Oxygen saturation monitoring

  • Blood pressure monitoring

 
Instructions for infiltration

 

 

 

It is imperative to follow the following instructions:


- Do not eat in the 6 hours preceding the analgesic gesture
- Do not drink in the 4 hours preceding the analgesic gesture (2 hours for water)
- Do not drive the day of the analgesic procedure
- Do not smoke in the 4 hours preceding the analgesic gesture
- The usual medications must be taken at the usual times with the minimum
of liquid possible. If in doubt about any of them, please let us know.


The pain can be increased for 2-3 days and you are given a sick leave to cover this period. However, there is no danger in going back to work the next day.


These actions should not normally be performed during anticoagulant treatment (Sintrom, Marcoumar, Xarelto, ...). Antiaggregating treatment (Aspirin, Plavix, ...) also increases the risk of bleeding and should be stopped if possible one week before the operation. Please ask your cardiologist if this treatment can be temporarily stopped. Do not forget to let us know if you are taking any such medication.


Don't forget to tell us about all your allergies , in particular:


- Allergies to iodine, to disinfectants (precise brand names if you know them)
- Allergy to cortisone (substance used: methylprednisolone)
- Allergy to local anesthetics or propofol


Depending on your possible allergies, a preliminary assessment by a doctor specializing in allergology should be carried out before the analgesic procedure can be performed.


If your general state of health is reduced , an anesthetic assessment by a doctor specializing in anesthesiology should be performed before the analgesic procedure can be performed.

For reasons of sterility and risk of loss, we ask you to come without jewelry and without a watch for the operation. It is also best to leave your values ​​with your loved ones to avoid a loss. Hearing aids can however be kept. A key locker is however at your disposal.

If you are unable to attend, please notify us at least 72 hours in advance , otherwise you will be charged a lump sum of 300.-. If the analgesic procedure cannot be performed due to non-compliance with the instructions, this lump sum will also be billed.