Procedural Sedation

Procedural Sedation

Midland Conscious Sedation was set up in 2017 to provide a safe, effective, high quality sedation service for patients undergoing treatment in healthcare clinics in Birmingham. We only use Consultant anaesthetists trained in intravenous sedation techniques with Advanced Life Support accreditation.

The group has provided procedural sedation for more than 3,000 patients undergoing a range of fertility, plastic surgical and general surgical treatments. The sedation technique is built on a platform of target-controlled infusions of propofol, intravenous benzodiazepines and short-acting opioids.
The benefits of procedural sedation are considerable:

1. Improved patient experience with rapid onset and offset of action, low levels of postoperative nausea and vomiting and early discharge home;

2. Cost effective with increased patient throughput, direct discharge to ward based care and low levels of conversion from day case to overnight stay.

We are continually exploring ways to improve our service and in November 2021 introduced Remimazolam a novel, ultrashort acting benzodiazepine into our procedural sedation technique. This agent is best suited to procedures lasting under 60 minutes and is used instead of midazolam. It delivers even faster sedation onset and offset of action.

We were the first clinicians to use this drug in the UK and our experience has been presented at various meetings over the last 6 months including the Euroanaesthesia Congress held in Milan in June 22.

Midland Conscious Sedation has focussed on developing services at stand-alone clinics for the last 5 years. Our experience is readily transferable to the hospital setting and we are now working towards introducing similar services in the hospital environment.


Dr Green has spoken about his experience of setting up and managing procedural sedation services and introducing the novel ultra-short acting benzodiazepine, remimazolam into a sedation technique at various hospitals in the Midlands and East of England over the last 18 months. He has also been invited to speak at a number of lectures:
Invited Speaker
Meet the Experts: Procedural Sedation and Remimazolam
Pan-London training Day
Health Education England
30th September 22

Setting Up a Safe Procedural Sedation Service
Educating Anaesthetists Promoting Wellness
St Anton, Austria
17th January 23

Procedural Sedation
Anaesthesia 2023
Royal College of Anaesthetists
Birmingham, UK
16th May 23
Sponsored Speaker (Paion)
Early Clinical Experience from the UK with Remimazolam
Euroanaesthesia 22
European Society of Anaesthesia and Intensive Care
Milan, Italy
5th June 22

Remimazolam Use in the Clinic: a Procedural Sedationist’s Experience
Anaesthesia and Critical Care 22
London, UK
15th November 22

The Impact of Remimazolam on Procedural Sedation service design: a Paradigm Shift?
Winter Scientific Meeting 2023
Association of Anaesthetists
London, UK
13th January 23


Conscious Sedation is "a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation..." - AoMRC (2013)

Deep Sedation refers to "a state where the patient cannot easily be aroused but responds purposefully to repeated or painful stimulation... the ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patient airway and spontaneous ventilation may be inadequate" - Anesthesiology (2018)

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