What is a Sedation Scale?

Mary McMahon
Mary McMahon

A sedation scale is a metric used for assessing the level of sedation in patients. Using a standardized scale allows care providers to set targets, as well as recording information about patients as accurately as possible in patient charts. A number of different scales for discussing sedation in different settings have been developed, including the Ramsay Sedation Scale and the Richmond Agitation Sedation Scale. Different facilities may prefer particular scales and will train their employees in the uniform application of the metric to their patients.

Conscious sedation, often used for medical testing and out-patient procedures, scores low on most scales because the patients are awake and breathing on their own.
Conscious sedation, often used for medical testing and out-patient procedures, scores low on most scales because the patients are awake and breathing on their own.

For medical procedures, sedation may be needed to facilitate the procedure, and a target sedation level is set when planning the procedure. For highly invasive procedures, general anesthesia is needed because the patient needs to be rendered completely insensate to pain, as well as unconscious. For more minor procedures like dental surgery on people who are nervous, only light sedation to keep the patient calm is necessary.

Light sedation can be used to keep patients calm during extensive dental procedures.
Light sedation can be used to keep patients calm during extensive dental procedures.

Sedation is also a topic of interest in intensive care and nursing facilities. Patients typically need to be kept under sedation while they are on ventilators, because fully aware patients may extubate themselves by pulling at the tubing and can experience distress. Patients can also be sedated as part of a pain management plan, keeping the patient less aware of pain and the surroundings for increased comfort.

An anesthesiologist administers sedatives through an intravenous line to help patients relax.
An anesthesiologist administers sedatives through an intravenous line to help patients relax.

Several qualities can be included in a sedation scale. The patient's level of awareness is one, as the difference between consciousness and unconsciousness is a useful marker that is easy to assess by seeing if a patient responds. Ability to cooperate with commands or answer questions can be a component of awareness or a separate measure, as can agitation and combativeness. Cardiovascular function is another concern, as patients who are heavily sedated may need cardiovascular support. Airway integrity is another issue; light sedation usually allows patients to breathe on their own and causes few airway concerns, while heavy sedation may require artificial ventilation and respiratory support.

Patients who rank in the middle third of a sedation scale may be given supplemental oxygen but most likely do not need other respiratory support.
Patients who rank in the middle third of a sedation scale may be given supplemental oxygen but most likely do not need other respiratory support.

A sedation scale may run from one to four, one to six, or even one to 10. Usually, the lower numbers indicate higher levels of awareness and activity, while higher numbers are used for more heavily sedated states. A basic scale might divide patients into light, moderate, heavy, and complete sedation categories. For each category, a checklist of qualities can be used to exclude or include the patient in that category; for example, in light sedation, a patient is awake, so if a patient is not responsive, the patient would automatically be excluded from that category.

Heavy sedation may require artificial ventilation and respiratory support.
Heavy sedation may require artificial ventilation and respiratory support.
A patient's level of awareness is one quality that can be assessed using a sedation scale.
A patient's level of awareness is one quality that can be assessed using a sedation scale.
Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a wiseGEEK researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

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