What are the risks of sedation?

During a procedure, conscious sedation lets you stay awake and aware, without feeling discomfort and without the stronger side effects and dangers of general anesthesia. Some patients may experience brief periods of sleep. Patients who receive conscious sedation are usually able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they may experience to the provider. A brief period of amnesia may erase any memory of the procedures. Conscious sedation does not last long, but it may make you drowsy.

What are the side effects of conscious sedation?

Sedation may slow your breathing and the nurse may give you oxygen.
Your blood pressure may be affected and you may get IV fluids to stabilize your blood pressure.
Because sedation effects may linger, you may have a headache, nausea, and feel sleepy for several hours.

Should I do anything special after conscious sedation?

For your safety, a responsible adult must take you home. This person must be available when you are ready for discharge. It is recommended that you have someone with you for the remainder of the day.

You will not be allowed to take a bus or taxicab without a responsible adult to ride with you.

Do not drive, drink alcohol, use machinery, or sign legal documents for 24 hours after receiving sedation.

A nurse, doctor, or dentist, will give you conscious sedation in the hospital or outpatient clinic. Most of the time, it will not be an anesthesiologist. The medicine will wear off quickly, so it is used for short, uncomplicated procedures.

You may receive the medicine through an intravenous line (IV, in a vein) or a shot into a muscle. You will begin to feel drowsy and relaxed very quickly. If your doctor gives you the medicine to swallow, you will feel the effects after about 30 to 60 minutes.

Your breathing will slow and your blood pressure may drop a little. Your health care provider will monitor you during the procedure to make sure you are OK. This provider will stay with you at all times during the procedure.

You should not need help with your breathing. But you may receive extra oxygen through a mask or IV fluids through a catheter (tube) into a vein.

You may fall asleep, but you will wake up easily to respond to people in the room. You may be able to respond to verbal cues. After conscious sedation, you may feel drowsy and not remember much about your procedure.

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American College of Radiology website. ACR practice parameter for the performance of ultrasound-guided percutaneous breast interventional procedures. www.acr.org/-/media/ACR/Files/Practice-Parameters/us-guidedbreast.pdf. Updated 2016. Accessed May 24, 2021.

Henry NL, Shah PD, Haider I, Freer PE, Jagsi R, Sabel MS. Cancer of the breast. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 88.

Thigpen DM, Huppe AI, Mehta AK, Brem RF. Breast biopsy and ablation. In: Mauro MA, Murphy KPJ, Thomson KR, Venbrux AC, Morgan RA, eds. Image-Guided Interventions. 3rd ed. Philadelphia, PA: Elsevier; 2021:chap 105.

Page 3

American College of Radiology website. ACR practice parameter for the performance of stereotactic-guided breast interventional procedures. www.acr.org/-/media/ACR/Files/Practice-Parameters/stereo-breast.pdf. Updated 2020. Accessed May 24, 2021.

Jones RC, Grant MD. Role of stereotactic breast biopsy in the management of breast disease. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:667-670.

Page 4

Bassett LW, Lee-Felker S. Breast imaging screening and diagnosis. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 26.

Hacker NF, Friedlander ML. Breast disease: a gynecologic perspective. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 30.

Phillips J, Mehta RJ, Stavros AT. The breast. In: Rumack CM, Levine D, eds. Diagnostic Ultrasound. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 21.

Siu AL; US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279-296. PMID: 26757170 pubmed.ncbi.nlm.nih.gov/26757170/.

Page 5

American Cancer Society website. American Cancer Society recommendations for the early detection of breast cancer. www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Updated April 22, 2021. Accessed June 4, 2021.

American College of Obstetricians and Gynecologists (ACOG) website. ACOG Practice Bulletin: Breast cancer risk assessment and screening in average-risk women. www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Breast-Cancer-Risk-Assessment-and-Screening-in-Average-Risk-Women. No. 179, July 2017. Reaffirmed 2019. Accessed June 3, 2021.

National Cancer Institute website. Breast cancer screening (PDQ) - health professional version. www.cancer.gov/types/breast/hp/breast-screening-pdq. Updated May 7, 2021. Accessed June 3, 2021.

Page 6

Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Page 7

Boland GWL. Colon and appendix. In: Boland GWL, ed. Gastrointestinal Imaging: The Requisites. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 5.

Boone D, Plumb A, Taylor SA. The large bowel. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 22.

Chernecky CC, Berger BJ. Barium enema. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:183-185.

Lin JS, Piper MA, Perdue LA, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(23):2576-2594. PMID: 27305422 pubmed.ncbi.nlm.nih.gov/27305422/.

Page 8

National Cancer Institute. Colorectal Cancer Prevention (PDQ) - Health Professional Version. www.cancer.gov/types/colorectal/hp/colorectal-prevention-pdq. Updated March 29, 2021. Accessed June 4, 2021.

Garber JJ, Chung DC, eds. Colonic polyps and polyposis syndromes. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier Saunders; 2021:chap 126.

Lawler M, Johnson B, Van Schaeybroeck S, et al. Colorectal cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 74.

Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016-1030. PMID: 28555630 pubmed.ncbi.nlm.nih.gov/28555630/.

Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281. PMID: 29846947 pubmed.ncbi.nlm.nih.gov/29846947/.

Page 9

Pasricha PJ. Gastrointestinal endoscopy. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 125.

Sugumar A, Vargo JJ. Preparation for and complications of gastrointestinal endoscopy. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 42.

US Preventive Services Task Force website. Final recommendation statement. Colorectal cancer screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Published May 18, 2021. Accessed June 29, 2021.

Page 10

American College of Radiology (ACR), the Society of Interventional Radiology (SIR), and the Society for Pediatric Radiology. ACR-SIR-SPR practice parameter for the performance of image-guided percutaneous needle biopsy (PNB). Revised 2018 (Resolution 14). www.acr.org/-/media/ACR/Files/Practice-Parameters/PNB.pdf. Accessed November 19, 2020.

Chernecky CC, Berger BJ. Biopsy, site-specific - specimen. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:199-202.

Kessel D, Robertson I. Achieving tissue diagnosis. In: Kessel D, Robertson I, eds. Interventional Radiology: A Survival Guide. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 38.

Olbricht S. Biopsy techniques and basic excisions. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 146.

Page 11

Butts C. Ultrasound. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 66.

Fowler GC, Lefevre N. Emergency department, hospitalist, and office ultrasound (POCUS). In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 214.

Merritt CRB. Physics of ultrasound. In: Rumack CM, Levine D, eds. Diagnostic Ultrasound. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 1.

Page 12

Blum M. Thyroid imaging. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 79.

Salvatore D, Cohen R, Kopp PA, Larsen PR. Thyroid pathophysiology and diagnostic evaluation. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 11.

Strachan MWJ, Newell-Price JDC. Endocrinology. In: Ralston SH, Penman ID, Strachan MWJ, Hobson RP, eds. Davidson's Principles and Practice of Medicine. 23rd ed. Philadelphia, PA: Elsevier; 2018:chap 18.

Page 13

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. PMID: 26462967 pubmed.ncbi.nlm.nih.gov/26462967/.

Filetti S, Tuttle M, Leboulleux S, Alexander EK. Nontoxic diffuse goiter, nodular thyroid disorders, and thyroid malignancies. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 14.

Jonklaas J, Cooper DS. Thyroid. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 213.

Page 14

Haugen BR, Alexander Erik K, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133. PMID: 26462967 pubmed.ncbi.nlm.nih.gov/26462967/.

Jonklaas J, Cooper DS. Thyroid. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 213.

National Cancer Institute website. Thyroid cancer treatment (adult) (PDQ) - health provisional version. www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional. Updated May 14, 2020. Accessed August 3, 2020.

Smith PW, Hanks LR, Salomone LJ, Hanks JB. Thyroid. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 36.

Thompson LDR. Malignant neoplasms of the thyroid gland. In: Thompson LDR, Bishop JA, eds. Head and Neck Pathology. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 25.

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Cancer cells multiply faster than normal cells in the body. Because radiation is most harmful to quickly growing cells, radiation therapy damages cancer cells more than normal cells. This prevents the cancer cells from growing and dividing, and leads to cell death.

Radiation therapy is used to fight many types of cancer. Sometimes, radiation is the only treatment needed. It may also be used in combination with other therapies such as surgery or chemotherapy to:

Shrink a tumor as much as possible before surgery
Help prevent the cancer from coming back after surgery or chemotherapy
Relieve symptoms caused by a tumor, such as pain, pressure, or bleeding
Treat cancers that cannot be removed with surgery
Treat cancers instead of using surgery

TYPES OF RADIATION THERAPY

Different types of radiation therapy include external, internal, and intraoperative.

EXTERNAL RADIATION THERAPY

External radiation is the most common form. This method carefully aims high-powered x-rays or particles directly at the tumor from outside of the body. Newer methods provide more effective treatment with less tissue damage. These include:

Proton therapy is another kind of radiation used to treat cancer. Rather than using x-rays to destroy cancer cells, proton therapy uses a beam of special particles called protons. Because it causes less damage to healthy tissue, proton therapy is often used for cancers that are very close to critical parts of the body. It is only used for certain types of cancer.

INTERNAL RADIATION THERAPY

Internal beam radiation is placed inside your body.

One method uses radioactive seeds that are placed directly into or near the tumor. This method is called brachytherapy, and is used to treat prostate cancer. It is used less often to treat breast, cervical, lung, and other cancers.
Another method involves receiving radiation by drinking it, swallowing a pill, or through an IV. Liquid radiation travels throughout your body, seeking out and killing cancer cells. Thyroid cancer may be treated this way.

INTRAOPERTIVE RADIATION THERAPY (IORT)

This type of radiation is usually used during surgery to remove a tumor. Right after the tumor is removed and before the surgeon closes the incision, radiation is delivered to the site where the tumor used to be. IORT is generally used for tumors that have not spread and microscopic tumor cells may remain after the larger tumor is removed.

Compared with external radiation, advantages of IORT may include:

Only the tumor area is targeted so there is less harm to healthy tissue
Only a single dose of radiation is given
Delivers a smaller dose of radiation

SIDE EFFECTS OF RADIATION THERAPY

Radiation therapy can also damage or kill healthy cells. The death of healthy cells can lead to side effects.

These side effects depend on the dose of radiation, and how often you have the therapy. External beam radiation may cause skin changes, such as hair loss, red or burning skin, thinning of skin tissue, or even shedding of the outer layer of skin.

Other side effects depend on the part of body receiving radiation:

Abdomen
Brain
Breast
Chest
Mouth and neck
Pelvic (between the hips)
Prostate

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Basen-Engguist K, Brown P, Coletta AM, Savage M, Maresso KC, Hawk E. Lifestyle and cancer prevention. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 22.

Doroshow JH. Approach to the patient with cancer. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 169.

National Cancer Institute website. Chemotherapy and you: support for people with cancer. www.cancer.gov/publications/patient-education/chemo-and-you. Updated September 2018. Accessed May 12, 2021.

National Cancer Institute website. Radiation therapy and you: support for people with cancer. www.cancer.gov/publications/patient-education/radiation-therapy-and-you. Updated April 2021. Accessed May 12, 2021.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34. PMID: 30620402 pubmed.ncbi.nlm.nih.gov/30620402/.

Page 17

Appelbaum FR. Acute leukemias in adults. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 95.

Hunger SP, Teachey DT, Grupp S, Aplenc R. Childhood leukemia. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 93.