Alternative sedation techniques Flashcards
What are the standard sedation techniques available?
IV sedation using midazolam alone
Inhaltional using NO/O
Oral and transmucosal sedation
What are the alternative sedation techniques?
Any form of sedation for under 12's other than inhaltional using NO/O BDZ + another agent Propofol + another agent Inhalational plus agents other than NO/O Combined sedation
When is a dedicated sedationist required during sedation?
SCSD 2007
when continuous IV infusion of a drug or where 3 or more drugs are used in combination regardless f the routes
What is oral sedation?
Production of a conscious state of sedation using an oral dose of a sedative agent and given under the supervision of a sedationist
What are the advantages of oral sedation?
Well accepted
Easy to administer
No injection
What are the disadvanatags of oral sedation?
Long latency period
Erratic absorption from GI which is affected by food, blood flow and drug formulation
Cannot alter depth of sedation
Prolonged duration of action
Which drugs are used for oral sedation?
BZD
Temazapem
Midazolam (best currently available)
What are the advanatges of temezapam?
It is long acting
What are the disadvantges of temezapam?
Gelatine capsule *cannot be used in vegans/muslim/veges/mixed with drinks
it has a slow onset
WHat are the advantages for midazolam as an oral sedative?
Rapid onset
effective sedation
widely available
can be mixed with drinks
What are the disad for midalzolam as an oral sedative?
bitter tatse no pre made formula 50% 1s pass metablism therfore low bioavalabilty Lag time Untitratable
What is first pass metabolism?
concentration of a drug is greatly reduced before it reaches the systemic circulation.
It is the fraction of lost drug during the process of absorption which is generally related to the liver and gut wall
How do you use midazolam as an oral sedative?
20mg for adults
0.5mg/kg children
monitor and wait and attatch pulse oximter asap
then use IV sedation
T/F the same level of sedation achieved with IV cannot be achieved with Oral sedation?
F
Need to be careful, needs same monitring as with IV
When is oral sedation useful?
those with needle phobics
learning difficulties
children where RA fails or likely to fail
What is transmucosal sedation?
this is where there has been the absorption of the active agent across the mucosal surfaces
What does transmucosal avoid?
paranternal routes and first pass metablism as with oral sedation
When may transmucosal sedation be useful?
In children following trauma
What agent is use in transmucosal sedation?
Midazolam
How much midazolam is used in transmucosal sedation?
0.3mg/kg
Where do you squirt the midazolam in transmucosal sedation?
into the nostrils
T/F multiple agent sedation is much better than single agent sedation?
F
Also there is a greater risk of unwanted side effects and synergistic reactions occurring
Which opioids care commonly used in combination with midazolam?
fentanyl and alfentanyl
What is the advantage of fentanyl and afentanyl?
Rapid onset
short acting
potent opioid agonist
WHat is the effect of opioids?
They produce sedation and analegesia
When using opioids together with midazolam, which one is given first?
opioid and then midazolam
What is the effect of fentanyl on respiration?
It causes respiratory depression which peaks at 10-30 minutes
What side effect do opiods have?
nausea and vomiting
What is the anatognost for opioids?
Nalaxone
What type of anaestehtic agent is ketamine?
a dissociatvie agent
What are the side effects using ketamine?
amnesia
hallucinations in 25% which are reduced when midazolam is also used
In what pateints would ketamine and midaolam be used?
children mainly
What other agents can ketamine be used in conjuction with?
Ketamine and midazolam
Ketamine midazolam and opioid
What is the effect of midazolam and ketamine together?
they produce analgesia
What is the effects of opioid and midazolam?
they priduce respiratory depression
What is the effect of midazlam alone?
this produces sedation
What is the effect of ketamine on respiration?
this is able to stimulate respiration
WHat is the effect of using ketamine, opioids and midazolam together? WHen would this combination be used?
the dose of each drug is then reduced
pt that become sedated but not anxilysed and pateints that require high doses of midazolam that actually produces an effect
Which two drugs can be used in oral sedation and why would you use them?
midazolama and ketamine for those pateints where midazolam is not very successful
Who can use propofol?
people trained in anaesthesia
Is the onset rapid or prolonged with propofol?
Rapid
less lag time between injection and effect
Is propofol short acting or long acting?
short
is the recovery time with propfol faster or slower than with midazolam?
faster
Where is propofol metabolosed?
liver and possibly lung
T/F Propofol can cause respiratory depression?
T
when used in anaesthetic doses
When is propofil useful?
long and short procedures and patients where high doses of midazolam have little or no effect
WHat are the alternatives to NO in inhaltional sedation ?
isoflurane and sevoflurane
