Twilight anaesthesia refers to a technique involving the application of a mild dose of anaesthesia to induce anxiolysis and hypnosis leading to the inability to form memories thus, enabling patients to feel comfortable during and after surgeries.
Twilight anaesthesia means that the patient will be fully sedated however, still conscious during the procedure. The patient can move and even communicate with the doctor. A local anaesthetic can be used alongside the twilight method ensuring an entirely pain-free procedure. The drugs used to through this sedation are similar if not the same to those used for general anaesthesia though the dosages vary.
The main difference between general and twilight anaesthesia is the level of consciousness the patient experiences. General anaesthesia involves placing the patient in an induced coma, which rendering them completely unconscious thus, causing a total loss of reflexes and control over the autonomous nervous system. The patient’s muscular functions become impaired therefore, requiring them to be placed on ventilator in order to breathe.
A patient undergoing twilight anaesthesia is partially conscious and does not need ventilation. Some patients fear going for cosmetic surgery due to the disadvantages surrounding general anaesthesia such as the induced coma, possible complications, and the cost.
As a result, the twilight alternative is becoming more popular among cosmetic surgeons however; it too comes with certain disadvantages.
Advantages of Twilight Anaesthesia
- Quicker Recovery Rate
Generally speaking, patients that undergo twilight anaesthesia compared to general sedation have faster recovery rates. This is a result of the constant state of consciousness therefore eliminating the reboot time the nervous system would need after an induced coma. The patient is also injected with drugs that reduce recovery pain.
- Reduced Side Effects and Complications
Traditional surgeries are associated with side effects such as nausea and vomiting. Twilight anaesthesia has recorded the same type of side effects though their rate of occurrence is much lower. Although all forms of anaesthesia could lead to complications, twilight anaesthesia has reduced risk due to the nature of its administration into the system. Some complications include sleepiness, feeling cold, and cardiovascular effects. These effects could last for some time depending on the patient.
- Less Costly
In comparison to general anaesthesia, the twilight method is cheaper. While the drugs administered are the same, the dosages required during twilight sedation are much less as the goal is not to induce a coma, rather relax the system. The smaller amount of drugs needed thus reduces the overall cost.
Disadvantages of Twilight Anaesthesia
Amnesia refers to the partial or total loss of memory. Amnesia usually occurs after the period of conscious sedation. The use of the drug Midazolam is administered to help with relaxation rather than pain reduction during the procedure. The effects of Amnesia are said to last about an hour after the administration of the drug but could last up to six hours. Patients should not be allowed to do various tasks that require concentration just sedation such as driving a vehicle.
- Cardiovascular Effects
A study by the University of Virginia shows that the drugs used for twilight sedation can cause Bradycardia, a condition resulting in an abnormally slow heart hate as well as Hypotension, also known as low blood sugar.
- Effects on the Central Nervous System
Sedation slows the central nervous system thus causes certain patients who have undergone twilight anaesthesia to experience agitation, dizziness, blurred vision and lack of body coordination.
- Feeling Cold
Many patients may wake up feeling extremely cold and shivering. This is deliberate as cool temperatures are required during surgical procedures to lower blood circulation thus lowering the rate of blood loss. As a result, surgery rooms have very low ambient temperatures.
Patients will come out of surgery feeling extremely fatigued. This is partly associated to the extreme physical stress imposed on the body during surgery as well as the emotional stress from being out of control during surgery. It can take a few days and up to a week to recover from post-surgery fatigue. The duration varies from one individual to another with contributing factors such as age, length and severity of the surgery, overall health and the types of drugs used for the sedation.
- Slurred Speech
When a patient wakes up from a twilight sleep, he or she experiences a slurred speech. It’s common to feel as though you have had too much to drink because the drugs used such as Fentanyl and Midazolam, depress the body’s reflexes in the same way as alcohol. Speech will return naturally once the drugs flush out of your system.
- Inadequate Anaesthesia
The drug dosage administered to induce a twilight sleep may not be enough for some people. Muscular young men and active kids who are often more nervous prior to surgery may need a second dosage to effectively sedate the patient.
- Prolonged Recovery
Most anaesthesia drugs used for the twilight method usually take two to three hours to clear out of the system allowing patient to go home and even continue with their days – although that is not recommended for proper recovery.
While twilight anaesthesia has been seen as the preferred sedation method, it is always important to first consult a surgeon and carry out the proper steps to ensure you are a good candidate for twilight anaesthesia.