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IV Sedation course > 2nd Week > Flashcards

2nd Week Flashcards

1
Q

preoperative assessment

A
  1. complete medical history
    - previous anesthetics, operations (and complications), obstetric history and pain history
  2. physical exam
  3. indicated lab studies or tests
  4. medical consultations as indicated
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2
Q

Ask patients about the three G’s

A
  1. Garlic
  2. Gingkoo
  3. Genseng- hypoglycemia, inhibition of platelets aggre
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3
Q

Fasting guidelines

A
  1. Clear liquids=2 hours (water, black coffee, pulp free juice, carbonated beverage),
  2. Break Milk = four hours, infant formula=6 hours
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4
Q

For general physical shape ask…

A
  1. can you go up a flight of stairs without any difficulty?
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5
Q

Airway evaluation

A
  1. Mallampati classification
  2. mentohyoid distance (4-6 normal)
  3. Mouth opening
  4. Nares
  5. Dentition
  6. Airway structions (tonsils, uvula, palates
  7. Obesity
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6
Q

Asa Classification

-Class I

A

normal healthy patient

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7
Q

ASA II

A

a patient with mild systemic disease (no functional limitations)

  • smoking
  • hypertension
  • uncomplicated diabetes
  • treated hypothyroidism
  • stable asthma
  • allergic rhinitis on medcation
  • GERD
  • Colitis
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8
Q

ASA III

A

a patient with severe systemic disease
-morbid obesity
-Coronary artery disease (including stent)
-

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9
Q

ASA 4

A

A patient with severe systemic disease that is a constant threat to life

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10
Q

ASA 5

A

a moribund patient that is not expected to survive without the operation

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11
Q

If they smoke, and everything else is healthy, what ASA class?

A

II

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12
Q

ASA class 6

A

a brain dead patient, organ donor

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13
Q

If the patient has asthma, can we sedate?

A

Yes, but have them take 2 puffs 15-20 minutes before the procedure. Probably best if they haven’t had a recent attack (within a month or so)

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14
Q

Patient on antidepressants…

A

rarely sedate

-“you can’t sedate crazy”

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15
Q

Benzodiazepines effect

A
  • Decreased Anxiety
  • Sedation
  • Anterograde amnesia??
  • Muscle relaxation
  • Decreased seizure threshold
  • Do not cause fatal intoxication in and of themselves
  • May produce coma at high doses
  • Do not producesurgical anesthesia
  • Awareness persists (eyes open)
  • Insufficient relaxation
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16
Q

Examples of Benzodiazepines we will use

A
  • Midazolam
  • Lorazepam
  • Diazepam
  • Triazolam
17
Q

administration of Flumazenil

A

• 0.2 mg administered over 10-15 seconds; onset 1-2 minutes

-it also reverses Z-drugs

18
Q

Z-Drugs,

A 
GABA agonists
• Zaleplon(Sonata)5and10mgcapsules
• Zolpidem (Ambien) 5 and 10 mg tablets
• Eszopiclone(Lunesta)1,2and3mgtablets
• Zopiclone(Imovane)5and7.5mgtablets
• Limiteddurationofaction
• Lowriskresidualeffects
• Littleeffectdaytimeperformance
19
Q

First line of defense for a laryngospasm

A

Positive pressure

-Oxygen is really good for the vocal cords

20
Q

next line of defense for a laryngospasm

A

100 mg Lidocaine given by IV

21
Q

what is a warning sign from laryngospasm?

A

Stridor sign

-patient struggling to breath

22
Q

If you have used both Versed and fentanyl and the patient is starting to have some respiratory depression, what should you give and why?

A

Narcan reverses narcotics (narcotics are more likely to cause respiratory depression),
-If you only used Versed and they are having some Resp Depression, the most important thing to do is give it TIME, other than that you can give flumazenil

23
Q

if you suspect that a patient aspirated vomit or emesis, what needs to be done?

A

They MUST have a chest x-ray

24
Q

If they are hypotensive, what drug should be considered?

A

ephedrine (about 10 mg, it will need to be diluted)

-and also increase the flow of the saline (you may actually do this first)

25
Q

Hypotension treatment

A
  • Place patient in trendelenburg position • Give IV fluids as tolerated
  • Administer supplemental O2 if needed • Vasopressors
  • Ephedrine 5-10 mg i.v.
  • Phenylephrine 50-100 micrograms i.v
26
Q

signs and symptoms of local anesthetic toxicity

A
  • Tinnitus (ringing in ears), metallic taste in mouth - be prepared to treat convulsions
  • Cardiac depression – low blood pressure, slow heart rate (initially heart rate can be fast if local contains epinephrine)

IV Sedation course (3 decks)

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