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Nastasja (16) has needle phobia. As she walks into the dentist's rooms, big-eyed and white-knuckled, her anxiety is obvious – despite the tranquilliser she already had an hour before. She's here to have her wisdom teeth removed.

She sits down in the dental chair and Prof James Roelofse, an anaesthesiologist, is at her side. He inserts a plastic tube, which is connected to a machine that regulates the flow of drugs used for sedation and pain relief, into her left hand. Nastasja protests, but admits afterwards that she didn't feel the needle prick.

As the drugs take effect, she becomes calmer and more relaxed. And, although her eyes are still half open, she becomes less aware of all the activity that's going on around her.

The dental surgeon proceeds by cleaning her mouth and injecting local anaesthetics into the palate – one of the areas of the body most sensitive to a needle prick. Nastasja doesn't blink an eye, her phobia forgotten.

The two doctors speak to her and she reacts, as if hypnotised. According to Roelofse, Nastasja wouldn't be able to recall much of what happened afterwards. And, to her, it would feel like the hour-long operation lasted only a few minutes.

A controlled state of depressed consciousness

Nastasja is one of thousands of patients who have recently discovered the wonder of conscious sedation – a controlled state of depressed consciousness, during which the patient still has control over the protective reflexes and breathing, and can react to physical touch and verbal instructions.

With conscious sedation, the anaesthesiologist's aim is to produce a restful state of mind, i.e. to make an uncomfortable operation comfortable, and to control pain.

The concept isn't a new one. In fact, conscious sedation was first applied in medical practice more than 150 years ago – but with the use of "laughing gas" (nitrous oxide).

Although different drugs are used nowadays, these aren't novel either. The same drugs and equipment that are commonly used to perform modern general anaesthesia are employed.

What sets conscious sedation apart from general anaesthesia, is the quantity and the time span in which the drugs are injected. Drugs are gradually added according to the response of the patient. Therefore, fewer drugs are given. This means that the anaesthesiologist has a lot more control over the process and that the patient remains conscious.

Local anaesthesiologist a world leader

At the forefront of these developments, is Prof James Roelofse, from the University of the Western Cape, in South Africa, and visiting Professor in Anaesthesiology at the University College London, UK, who has spent the last 18 years refining techniques.

Roelofse and other colleagues started experimenting with conscious sedation in an attempt to eliminate the backlog of patients waiting for dental surgery at Cape Town's Tygerberg Oral Health Centre in the 1980s.

As a result, modern techniques have been developed, simplified, and made safe for use by careful and responsible persons.

Why should you opt for conscious sedation?

During the last years, conscious sedation has become popular for use in a variety of different settings and for different types of procedures. Here's why:

• Recovery is quick. Normal activity can usually be resumed within 12 hours after the operation.
• There is residual pain relief, in other words pain relief for a while after the procedure.
• It is convenient. Conscious sedation can be practised in theatres, freestanding facilities or in the dental or medical practitioner's office (given that all the necessary monitoring equipment is available). These locations are often less intimidating to patients who are anxious.
• It saves costs, as theatre and overnight hospital fees are cut.
• The side-effect profile is low. According to an American study, 96 percent of patients experience no side effects, like nausea and vomiting, which can be a common complaint after general anaesthesia.
• It is safe. The patient's level of consciousness, lung and heart function are all carefully monitored throughout the procedure to reduce possible risks. Computer-controlled infusion pumps increase the accuracy and patients have complete control over breathing. The protective reflexes – coughing and swallowing – also remain intact and communication is possible.

Who can benefit from it?

The unfamiliar environment of doctors' rooms, past traumatic experiences, fear of separation, and fear of pain can be a great source of anxiety especially for a child who has to undergo a surgical operation.

For this reason, children can be excellent candidates for outpatient procedures performed under conscious sedation. The procedure can be done in a facility with all the monitoring equipment and trained personnel available to make it safe.

A parent can remain in the facility to comfort the child. And as the child is conscious throughout the procedure, the doctor can comfort the child by communicating with him or her.

However, conscious sedation can be applied to adults and children alike – especially in circumstances where fear, anxiety or patient discomfort is involved.

Although it was first developed for use in dental procedures, conscious sedation is now widely used for many procedures:

• Less invasive surgical procedures where local anaesthetics are used, like cosmetic/plastic surgery and ear, nose and throat operations;
• Endoscopic procedures, like gastroscopies and colonoscopies;
• Interventional radiology;
• In-vitro fertilisation.

Practical considerations
If you consider having a procedure done under conscious sedation, discuss the possibility with your doctor, dentist or specialist. Many anaesthesiologists around the country are trained to do it. Your doctor should be able to point you in the right direction.

Most medical aid schemes are keen to cover the procedures, as conscious sedation can be a cheaper alternative to general anaesthesia under certain circumstances. Contact your medical scheme beforehand to check with them.

Your doctor will advise you to eliminate eating and drinking for several hours before the procedure. You will also be asked to sign a document of informed consent beforehand, and given instructions as to pre- and postoperative care.