The use of deep sedation or general anesthesia, during which the patient becomes briefly nonresponsive to verbal commands, has come under much scrutiny.
10,24 Advocates state that sedation allays anxiety, allowing treatment in a population that could not otherwise receive treatment; and renders patients temporarily immobile during these procedures and reduces the risk of sudden movement, thereby potentially decreasing the risk of neural injury.
10,24–26 Opponents cite ample anecdotes in the form of case reports, in which a responsive patient reported symptoms as a needle contacted a peripheral nerve or the spinal cord itself, allowing the procedure to be discontinued and causing no permanent neural injury.
10,24,25,27,28 Indeed, a recent consensus group concluded that warning signs, such as paresthesia or pain on injection of a local anesthetic, inconsistently herald needle contact with the spinal cord; however, some patients do report warning signs of needle-to-neuraxis proximity. The group warned that general anesthesia or heavy sedation removes any ability for the patient to recognize and report warning signs;
they recommended that neuraxial regional anesthesia should rarely be performed in adult patients whose sensorium is compromised by general anesthesia or heavy sedation.10 Although imperfect, the current analysis supports the notion that use of sedation or general anesthesia and conduct of cervical procedures in unresponsive patients are associated with a significant increase in the likelihood of permanent spinal cord injury.
