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What Is the Ramsay Sedation Scale?

By Matt Brady
Updated Mar 03, 2024
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The Ramsay Sedation Scale is used to measure different levels of sedation in medical patients. Of the various sedation scales used in anesthesiology, the Ramsay Sedation Scale has been one of the most widely adopted since its introduction in 1974. The scale monitors stages of sedation using a six-level scale—level one representing the least amount of sedation and six the most. The Ramsay Sedation Scale is divided into two parts: levels one through three monitor waking levels, and levels four through six monitor sleeping levels.

Of the waking levels, level one represents the most awake, with patients displaying a combination of being restless, anxious and agitated. Level two patients are more peaceful, patient and cooperative. Level three patients are the least responsive while still retaining consciousness, responding only to commands.

Of the sleeping levels, level four represents the least asleep, with patients able to quickly respond to a light tap or loud noise. Level five patients respond sluggishly. Level six patients are completely sedated, unable to respond to any stimulus.

Dr. Michael A.E. Ramsay, an anesthesiologist who became president of the Baylor Research Institute, developed the Ramsay Sedation Scale during a clinical study that monitored the various sedation levels of patients using a sedative called alphaxalone-alphadolone, or Althesin. The study attempted to optimize levels of sedation in various patients, with satisfactory levels ranging between two and five. The results of the study were published in the British Medical Journal, in an article titled "Controlled Sedation with Alphaxalone-Alphadolone."

The use of sedation scales has become commonplace in the field of anesthesiology. The Ramsay Sedation Scale is commonly used, but there are several other scales used as well, such as the Richmond Agitation Assessment Scale, the Motor Activity Assessment Scale and the Sedation Agitation Scale. All scales are used to ensure that a patient is receiving the optimal dose of a sedative.

Sedation scales are an important tool in the medical industry, used by anesthesiologists, doctors and nurses alike. Medical professionals train staff members to recognize and assess different levels of sedation to ensure optimal treatment. Excessive and insufficient doses of a sedative can lead to unwanted effects—too little and the patient may experience discomfort and pain; too much and the patient may be too sedated and take an excessive amount of time to recover. Sedation scales are used in concert with other tools to track patients' health and comfort levels during sedation.

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Discussion Comments

By jcraig — On Jul 12, 2011

Is there a similar scale used for local anesthesia? When I had a filling put in, I had local anesthesia. I was still conscious and functioning, but didn't feel pain, just pressure.

I've heard of nitrous oxide, and the article mentions Althesin, but what are some of the other common sedatives that are used? Are there different types used for different surgeries or for different effects? Also, are there any negative side effects of being "knocked out"?

By Emilski — On Jul 11, 2011

@TreeMan - I think knowing how sedatives work would be important? Unfortunately, I don't know the answer.

Does it go through the same mechanisms as alcohol? After drinking enough alcohol, you definitely start to have decreased sensations, so if anesthesia works the same way, I would imagine that you could undergo minor procedures and still be conscious. Of course, if you start to lose control of your judgment and motor skills like when drinking, you might just end up causing problems.

By matthewc23 — On Jul 10, 2011

@TreeMan - I remember having some fillings put in when I was younger. I assume that they used nitrous oxide to sedate me. (It was some sort of gas at least.)

It was a long time ago, but going by the descriptions in the article, I would say I remember most things up through about level 4. At that point it was almost impossible to stay awake. I don't really remember what sensations I had at that point, though.

By TreeMan — On Jul 09, 2011

I have never had surgery or major dental work, so I don't have any experience with being sedated. Is level 6 the only point where you can't feel pain, or are there different pain thresholds at each level? For example, can someone at 4 can feel certain sensations, but not others?

I also found myself wondering how well the different sedatives worked? Can every type of sedative make you reach a Ramsay score of six, or do some of them stop at a different level?

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