I had a spinal with something like valium but no sedation. DH had prepared some of my favourite music on his i-pod. The first knee was very complicated and long, as they had to cut and scrape a lot of extra bone growth around a severe injury from 50 years before. The noise was truly impressive- but I didn't panic or stress. The anesthetist promised me that if I did, he would get me out of it and make me sleep.
So much better, especially in older people, to preserve brain cells and avoid future complications. The second one was much quicker and easier, and I was totally fine without sedation, took 50% less time too.