anxiety, phobia and conscious sedation Flashcards
May cause a patient to experience an unpleasant state of tension forewarning danger.
ANXIETY
General feeling of impending doom even though the danger is not real.
PANIC DISORDER
• Psychological Condition that consists irrational fear leading to avoidance. of
• Claustrophobia, the fear of tight and enclosed spaces, is one example of such phobia.
PHOBIA
TWO (2) MAJOR SOURCES OF ANXIETY
PHYSICAL CONDITIONS OF THE MRI
EMOTIONAL TURMOIL
The physical conditions were such that the patient was unable to see outside the tube or to move while in the tube. Equally distressing was the unbearable noise of “metal being crunched.”
PHYSICAL CONDITIONS OF THE MRI
Resulted from the fear of what the MRI might show.
EMOTIONAL TURMOIL
• A drug-induced relaxation allowing the patient to tolerate unpleasant procedures.
• The patient remains Conscious, but sedated, and in some cases amnestic (loss of memory) at the time of the procedure.
CONSCIOUS SEDATION
AGENTS USED FOR CONSCIOUS SEDATION
- barbiturate
- benzodiazepine
- opiate analgesic classes of drugs
BARBITURATES
INCLUDED MEDICATIONS:
• THIOPENTAL
• METHOHEXITAL
• PHENOBARBITAL
• Used mostly in the surgical suite to induce full anesthesia.
• Used rectally for pediatric conscious sedation before MRI studies.
• Given through a female-type urinary catheter inserted rectally.
THIOPENTAL
THIOPENTAL
PROPER DOSAGE FOR INFANTS:
• Under 6 months: 50 mg/kg
• Ages 6-12 months: 35 mg/kg
• Ages greater than 12 months: 25 mg/kg
THIOPENTAL
MAJOR ADVERSE EFFECTS
• Bronchospasm
• Hypotension with rebound tachycardias
• Apnea
• Respiratory depression
• Paradoxical excitation and agitation
• GI upset
• Exacerbation of porphyria
• Extremely rapid in onset and very short in duration
• Mostly for brief procedures, such as cardioversions and electroconvulsive therapy (ECT), and for anesthesia induction
• Used as a rectal preparation for pediatric Conscious sedation before CT studies
METHOHEXITAL
METHOHEXITAL
MAJOR ADVERSE EFFECTS
• Bronchospasm
• Hypotension with rebound tachycardias
• Apnea
• Respiratory depression
• Paradoxical excitation and agitation
• GI upset
• Exacerbation of porphyria
• 30 mg orally may be given to an adult patient the night before and the morning of the scheduled radiographic study to keep the patient calm.
PHENOBARBITAL
PHENOBARBITAL
MAJOR ADVERSE EFFECTS
• Bronchospasm
• Hypotension with rebound tachycardias
• Apnea
• Respiratory depression
• Paradoxical excitation and agitation
• GI upset
• Exacerbation of porphyria
Used for conscious sedation
Cause selective CNS depression, muscle
relaxation, antianxiety, anticonvulsant, and
sedative-hypnotic activities.
BENZODIAZEPINES
BENZODIAZEPINES
ADVERSE REACTIONS
Excessive drowsiness
• hiccups (midazolam)
• Lassitude
•decreased dexterity
• dry mouth
• GI upset
• blurred vision
• amnesia,
• paradoxical excitation
• hallucinations
• choreiform spasmodic movements
• headache
• Most widely used benzodiazepine for conscious sedation
• Very predictable and quick in onset with a short duration of action
MIDAZOLAM
• Stimulate the decrease ease pain CNS opioid receptors perception. When used to in combination with the antianxiety medications, the opiates allow for decreased anxiety.
OPIATE ANALGESICS
OPIATE ANALGESICS
ADVERSE REACTIONS
•Excessive drowsiness
• Drowsiness
• GI upset
Urinary retention
Dizziness
Headache
• Lightheadedness
• Histamine release
• Confusion
Hallucinations
Hypotension
• Respiratory depression
OPIATE ANALGESICS
3 ΜΑΙΝ OPIATES:
morphine
meperidine
fentanyl
: 0.08 to 0.15 mg/kg IV in adults and 0.1 mg/kg IV in pediatric patients
Morphine
: 1 to 3 mg/kg IV in adults and is not recommended for children
Meperidine
: I to 5 micrograms (µg)/kg IV in adults and 1 to 5 µg/kg IV in pediatric patients
Fentanyl
