8. Parenteral II Flashcards
Patients above ASA class _ should be sedated in a hospital setting
II
Pre-anesthetic preparation to avoidemesis and aspiration
- NPO 6-8 hrs prior to procedure
- May need to take meds with sipds of water
- Adjustments in oral hypoglycemic and or insulin regimen for diabetics
Anesthesia should be postponed if the pateint has what kind of infection
upper/lower respiratory infection
What is the difference between Hypertensive urgency and emergency
Both have high BP readings
- Urgency- patient feels fine
- Emergency- feels like they have the flu and chest is tight
Profound respiratory depression can lead to
hypoxia
Adverse drug reactions can occur in patients that
- Substance abusers
- Hepatic or renal insufficiency
What is the biggest risk of IV sedation
respiratory depression (you stop breathing)
What types of monitors are meeded during sedation
- BP
- Pulse
- Heart rate (pulse)
- Heart rhythm (ECG)
- Oxygenation/ventilation (pulse oximeter, pre-cordial stethoscope)
- Temperature
What is the easiest and least accurate way to obtain patient temperature
skin temp
Discharge criteria for sedated pateints is
Aldrete score (must be 10 or more for discharge)
Primary reason we give opiods is
analgesia
Sequelae of OD on opiods is
respiratory depression 9Chest-wall rigidity)
Opiods leads to decrease in (sympathetic/parasympathetic stimulation
sympathetic
Naloxone can lead to
dysrhythmia, myocardial failure and pulmonary edema
What is the most potent opiod
sufentanyl (more then fentanyl)
Locaiton of the GABA receptors acted on by benzons
cerebral cortex and limbic system
Uses of benzos are
anxiolysis
anterograde amnesia
sedation
What is the most commonly used benzo and why
midazolam- no active metabolites and fast on fast off
Contraindications of benzons
- Allergy
- Narrow angle gluacoma
- Extremes of age (use anti-histamines)
MOA of ketamine
-Blocks CNS NDMA receptors (excitatory receptors0 resulting in sedation
Advantages of ketamine
not much depression in heart and respiratory function like opiods
Disadvantages of ketamine
extreme psychological effects on people (emergence phenomena- unpleasant visuals, auidtory or proprioceptive phenomena)
MOA of propofol
Bites a site associated with GABA
Effects of propofol
sedation (little analgesia) - can stop patient from breathing rapid bolus dose administration shouldn’t be used for ASA III, and IV patients
Effect of Benzos
- Anxiolysis
- Sedation
- Anterograde amnesia
Effect of opiods
- Analgesia
- Sedation
Effects of ketamine
- Analgesia
- Dissociation
- Sedation
What is the most common mixture of sedation agents
opiod and benzo
Agents used in Jorgenson
pentobarbital, meperidine, scopolamine
Agents in Foreman
Diazepam methohexital
Agents in Berns
secobarbital, meperidine, and methohexitol
Agents that can be used alone for sedation
- propofol
- Benzo
- Opioid
- Ketamine
Continuous infusion of single agent analgesic is done with
propofol
What happens to the doss of anesthetic agents when multiple types are used
dose of all of them declines
T/F N2O reduces need for higher conc. levels of benzos and opiods
t
