Twilight Sedation Guide

Concerned about general anaesthesia? Fortunately, a local anaesthetic with sedation ( 'twilight sedation') can be a safer option.

Twilight Sedation Guide

Written by Medical Quality Officer, David Jones , MPharm

Medical Review by Chief Commercial Officer, Dr. Lizzie Tuckey , MBBS, BA

Published: Friday 7 June 2024

Twilight sedation (another name for local anaesthesia with sedation) is an increasingly popular sedation method for many types of surgery. But what is it, and how does it differ from general anaesthetic? We’ll answer these questions as well as consider the pros and cons of twilight sedation so you can decide if it’s right for you.

What is anaesthesia?

The term anaesthetic literally means “without sensation” and describes medications that make patients unconscious and numb to any feeling, especially pain. Anaesthetics do this by blocking the nerve impulses that transmit sensations to the brain.

There are two broad categories of anaesthesia: local and general.

General anaesthesia (also called GA) blocks feeling in the body from being sensed at all. It is administered via a gas administered (given to a patient) through a mask or intravenously (injected into the bloodstream directly). Patients must be helped to breathe by a machine called a ventilator when under general anaesthesia because the body is unable to breathe on its own due to the way GA works.

GA is often used for more serious operations like orthopaedic treatments or surgeries that cause quite a bit of trauma to the body. It works well in these procedures because the patient is completely unconscious and unaware of the surgery being performed.

Local anaesthesia, on the other hand, numbs a localised part of the body while the patient remains awake and aware. Local anaesthetics are delivered via injection or topically in a gel or cream applied to the skin.

As it only numbs a relatively small area of the body at a time, it is more appropriate for less invasive procedures than GA. Plus, ventilation is not required during local anaesthesia. If you’ve ever had dental caries filled or a skin biopsy, you’ve likely had a local anaesthetic. There are several further types of anaesthesia, including spinal anaesthesia and epidurals, that we will not cover here, but more information on them can be found here.

What is twilight sedation?

Different methods of anaesthesia can be combined to produce specific levels or types of awareness and pain-blocking. Essentially, this is what twilight sedation is: a combination of local anaesthetic with sedation.

During twilight sedation, the patient receives anaesthetic medication to numb a specific part of the body, as well as a sedative to allow them to feel sleepy while still being awake and responsive. The sedative allows the patient to fall into a deep state of mental and physical calm though they never become entirely unconscious. This means that they can sense pressure and movement but no pain in the area where local sedation was administered.

Twilight sedation can also be referred to as local with sedation.

Patient under anesthesia

Advantages of twilight sedation

One of the more noteworthy benefits of local anaesthetics, including twilight sedation, is that it’s simply safer than GA. Since you don’t lose consciousness completely, recovery from twilight sedation is generally faster and less complicated than recovery after general anaesthesia.

The likelihood of side effects and complications is typically also much lower after local or twilight sedation than after general anaesthesia. Another benefit that many patients appreciate is that twilight sedation is almost always more affordable than a GA.

At Medbelle, we’re aware that many patients are nervous about general anaesthesia and may even consider cancelling a procedure entirely for fear of the risks. Some patients specifically request twilight sedation because of the reduced chance of risk compared to general anaesthetic, and that’s why most of our surgeons now offer it routinely for certain procedures. Ultimately, surgical procedures of all kinds come with a degree of risk. Taking the time to discuss your concerns and needs with your Medbelle surgeon allows you to make an informed decision that you’ll feel comfortable with.

Potential side effects of twilight sedation you should know about

Controlling pain during and after surgery can be a delicate process, and this is why your anaesthetist will take care to tailor the type of anaesthetic to your body, procedure and preferences. During any procedure requiring anaesthesia, you will be closely monitored by your surgeon and anaesthetist. The anaesthetic will be adjusted as necessary to make sure you’re neither too drowsy nor too alert.

Both local and general anaesthetics wear off a few hours after being administered. Common side effects after waking from anaesthetic can be bothersome but don’t typically last for long: you may feel nauseous, dizzy, faint, cold or strangely itchy.

Headaches, bruising, soreness, and pains are relatively common side effects. Blurred vision is common after anaesthesia, as are numbness, weakness, twitching muscles, and a “pins and needles” sensation. Some patients also experience difficulty urinating for a short while after anaesthesia.

Though unpleasant, these symptoms will normally subside as your nerves “wake up” again and re-establish normal communication with your brain. If you’re concerned about side effects or have a condition that may be made worse by anaesthesia, it’s essential to talk to your anaesthetist beforehand.

Let your surgeon know if you experience any worrying symptoms after surgery, including pain – in many cases, it’s a simple matter to soothe these side effects or adjust pain medication to make you feel more comfortable.

Consultation with a male surgeon

More serious rare complications

The vast majority of procedures under both local and general anaesthetics are carried out without any trouble. Improvements in both medical understanding and the drugs and equipment used mean anaesthesia are safer for patients today than ever before.

Nevertheless, there is a very small risk of more serious complications that every patient should understand before deciding to have a procedure.

Rare complications of general anaesthetic include nerve damage that can lead to paralysis in approximately 1 in 1000 people. Allergic reactions to the medication can occur in around 1 in 10,000 or 20,000 people, and there is a 1 in 100,000 chance of death.

However, these risks can vary depending on the presence of specific pre-existing medical conditions, whether you smoke or are overweight, what type of procedure you opt for and the kind of anaesthetic used. More minor procedures carried out under local anaesthetics with sedation are generally safer, and a skilled anaesthetist will take measures to reduce potential risks wherever possible.

How do I know if twilight sedation is right for me?

An anaesthetist will take the time to consider which type of anaesthetic is best suited for you and your procedure. This is especially important given that even the safest techniques still carry some risk of complication. Surgeons have found that twilight sedation can work especially well for less invasive procedures.

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