Monitored anaesthesia care (MAC) is being administered to a 70-year-old for a colonoscopy. The target sedation level is a patient who responds purposefully to verbal commands. This corresponds to which Ramsay Sedation Scale score and which ASA definition of sedation level?

• A Ramsay 5 (responds sluggishly); deep sedation
• B Ramsay 2 (cooperative, tranquil); minimal sedation
• C Ramsay 6 (no response); general anaesthesia
• D Ramsay 3 (responds to verbal commands only); moderate (conscious) sedation ✓

Explanation

Moderate sedation (formerly conscious sedation) is defined by ASA as a drug-induced depression of consciousness during which patients respond purposefully to verbal commands alone or accompanied by light tactile stimulation. Ventilatory and cardiovascular functions are maintained. Ramsay sedation scale: 1=anxious/agitated, 2=cooperative/tranquil, 3=responds to verbal commands only, 4=brisk response to glabellar tap, 5=sluggish response to painful stimulus, 6=no response. Purposeful response to verbal command = Ramsay 3 = moderate sedation. Deep sedation requires painful stimuli for purposeful response (Ramsay 4–5).

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.