Procedural sedation is most risky when patients
are disinhibited as they descend toward somnolence. By definition,
only during general anesthesia will make patients not respond to
painful stimuli. Therefore, during any procedural sedation the administration
of pain will result in patients becoming more stimulated and less sedate.
As this stage of disinhibition is the most risky, it is important
to reduce pain from procedures as much as possible using local or
regional analgesics. While some sedatives have analgesic properties
(ketamine, nitrous, dexmedetomidine) their effects alone are either
brief or insufficient for most severely painful procedures (abscess
drainage, joint aspiration, laceration repair).