3. Complications of Conscious Sedation

Question 1

Define conscious sedation.

Answer 1

Produces a state of depression of CNS where verbal contact is maintained through sedation period and the margin of safety is wide enough to render loss of consciousness is unlikely.

Question 2

What is the elimination half life of midazolam - IV sedation ?

Answer 2

1-2 hours.

Question 3

How long is midazolam in the system for - IV sedation ?

Answer 3

Up to 12 hours.

Question 4

What is the distribution half life of midazolam - IV sedation ?

Answer 4

15 mins.

Question 5

What does distribution half life mean ?

Answer 5

How long it takes for the drug to spread throughout the body and produce therapeutic effect.

Question 6

What are the five complications associated with cannulation in IV sedation ?

Answer 6

Venospasm.
Extravascular injection.
Intra-arterial injection.
Haematoma.
Fainting.

Question 7

How should venospasm be managed ?

Answer 7

Time dilating vein - worse with repeated attempts.
Efficient technique - quick, slow puncture makes worse.
Warm water/gloves in winter.

Question 8

What are the symptoms of extravascular injection ?

Answer 8

Pain and swelling.

Question 9

What is the main issue associated with extravascular injection ?

Answer 9

Delayed absorption into bloodstream.

Question 10

What are two prevention techniques to minimise risk of extravascular injection ?

Answer 10

Good cannulation.
Test dose of saline.

Question 11

What are the symptoms of intra-arterial injection ?

Answer 11

Pain on venipuncture.
Red blood in cannula.
Difficult to prevent leaks.
Pain radiating distally from cannulation site.
Loss of colour or warmth to the limb.
Weakening pulse.

Question 12

What are the four management techniques in prevention of intra-arterial injection ?

Answer 12

Monitor loss of pulse - cold and discolouration.
Leave cannula in situ for 5 mins post-drug.
No problems - remove.
Symptomatic - leave cannula in and refer to hospital.

Question 13

What treatment is given in hospital for management of intra-arterial injection ?

Answer 13

Procaine 1%

Question 14

What are the four causes of a haemtoma ?

Answer 14

Extravasation of blood into tissues due to damage to vein walls at venepuncture (poor technique) or at removal of cannula (failure to apply pressure).

Question 15

What patients are more likely to suffer haematoma ?

Answer 15

Elderly.

Question 16

What are the five complications associated with complications of drug administration following IV sedation ?

Answer 16

Hyper-responders.
Hypo-responders.
Parodoxical reactions.
Oversedation.
Allergic reaction.