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BDS4 CDS Sedation Symposium > 1. Intravenous Sedation > Flashcards

1. Intravenous Sedation Flashcards

1
Q

What is the mode of action of a benzodiazepine drug ?

A

Acts on receptors in CNS to enhance effect of GABA and to mimic effect of glycine on receptors - slows repolarisation time.

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2
Q

What is glycine ?

A

Similar inhibitory neurotransmitter that works on brainstem and spinal cord.

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3
Q

What allows benzodiazepines to attach to receptors in NS ?

A

Benzene ring.

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4
Q

What is the respiratory effects of benzodiazepines ?

A

Respiratory depression.

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5
Q

Why does benzodiazepines cause respiratory depression ?

A

CNS depression causing muscle relaxation.
Decreases cerebral response to increasing CO2 i.e. causing inhalation of air.

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6
Q

What is the cardiovascular effects of benzodiazepines ?

A

Reduced BP by muscle relaxation decreasing vascular resistance.
Increased HR due to baroreceptor reflex compensating for BP fall.

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7
Q

What are the three main drug interactions associated with benzodiazepines ?

A

Any other CNS depressants.
Erythromycin.
Antihistamines.

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8
Q

4 main side effects of benzodiazepines ?

A

Tolerance.
Dependence.
Drug interactions.
Sexual fantasies.

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9
Q

Why is diazepam no longer used ?

A

Insoluble in water, suspension in propylene glycol causing lots of pain on injection.
Elimination half life long & unpredictable.
Slower onset.
Risk of rebound sedation.
Longer recovery.
Unpredictable.

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10
Q

What is the preparation of midazolam used ?

A

5mg/5ml (pH 3.5).

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11
Q

What is the elimination half life of midazolam ?

A

90-150 minutes.

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12
Q

Where is midazolam metabolised ?

A

Liver.
Extra hepatic metabolism in bowel - less affected by liver disease.

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13
Q

What are the benefits of midazolam which means it is ‘gold standard’ sedation drug of choice vs. diazepam ?

A

Painless.
Quicker onset.
Quicker recovery.
More reliable.
Cheaper.

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14
Q

What cannula should be used for IV sedation ?

A

In-dwelling cannula (Teflon) - rarely blocks and more secure.

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15
Q

Why should a butterfly cannula not be used ?

A

Clots and obstructs.
Easily dislodged.

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16
Q

What are the two cannulation sites ?

A

Dorsum of the hand - metacarpal veins.
Antecubital fossa.

17
Q

What is the function of flumazenil ?

A

Reversal agent - antagonist of benzodiazepines.

18
Q

How often should blood pressure be checked throughout treatment ?

A

Every 5-10 mins.

19
Q

In what regime should midazolam be administered ?

A

1mg/1ml in 5mg/5ml vial.
2mg bolus.
1mg increments every 60 secs until appropriate response of the patient.

20
Q

How to check for anaesthesia ?

A

Slurring and slowing of speech.
Relaxed.
Delayed response to commands.
Willingness to accept treatment.
Verrill’s sign-ptosis.
Eve’s sign - shut eyes and touch nose i.e. loss of motor coordination.

21
Q

Maximum dose of midazolam in dental setting ?

A

7.5mg.

22
Q

How long will sedation typically last ?

A

45 mins.

23
Q

When can a patient be discharged and allowed to go home ?

A

60 minutes post-last increment.
Can walk unaided.

24
Q

What are the stages if a patient falls into respiratory depression ?

A
  1. Head tilt, chin lift, jaw thrust.
  2. Oxygen via nasal cannuale (2l/min).
  3. Oxygen via Hudson mask (15l/min).
  4. Flumazenil.
25
Q

What is the preparation of flumazenil used ?

A

500mcg/5ml.

26
Q

What dosage of flumazenil should be administered and in what routine ?

A

200mcg then 100mcg increments every 60 seconds until response is seen.

27
Q

What is the problem with flumazenil ?

A

Shorter half life than midazolam - 50 mins, therefore, risk of re-sedation.

28
Q

What ASA types can be treated in primary care with IV sedation ?

A

ASA1 and ASA2 (ASA3 depending on nature of procedure).

29
Q

What ASA types can be treated in secondary care with IV sedation ?

A

ASA3 and ASA4

30
Q

Define pharmacodynamic interactions.

A

Interactions between drugs which have similar or antagonistic pharmacological effects or side effects.

31
Q

Define pharmacokinetic interactions.

A

One drug alters the absorption, distribution or metabolism or excretion of another, thereby increasing or reducing the amount of drug available to produce its pharmacological effects.

32
Q

A pregnant woman - what is their ASA classification ?

A

ASA2

33
Q

What vital signs can be recorded from the blood pressure and pulse oximeter machine ?

A

HR, BP, O2 saturation.

34
Q

What is the weight cut off for sedation ?

A

BMI 35.

BDS4 CDS Sedation Symposium (4 decks)

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