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BDS4 Sedation > Complications Of Conscious Sedation > Flashcards

Complications Of Conscious Sedation Flashcards

1
Q

What drug is used to undo effects of medazolam

A

Flumazenil

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2
Q

When should flumazenil be used to reverse sedation?

A

Only in an emergency (ie not to speed up recovery time)

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3
Q

How should the dose of medazolam be given

A

Titration based on patients response (slow and safe)

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4
Q

What concentration of medazolam should be given

A

1mg per 1ml

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5
Q

What IV sedation complication types are there?

A
  1. Venospasm
  2. Extra vascular injection
  3. Intra arterial injection
  4. Haematoma
  5. Fainting
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6
Q

What is venospasm

A
  • When you put a cannula into the hand and the vein vanishes the minute you go in (collapses)
  • disappearing vein syndrome
  • may be accompanied by burning
  • associated with poorly visible veins
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7
Q

Describe the management of venospasm

A
  • make sure vein is well titration beforehand by e.g. putting turnoquay on then tapping vein to dilate it (worse with repeated attempts)
  • efficient technique (slow skin puncture makes worse)
  • warm water/ gloves in winter
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8
Q

What is an extra vascular injection

A

You put the cannula in, you think it is in the vein but its not. You give the drug but the drug will be out the vein and into the surrounding tissues (painful). Could end up with overdosing problems

Active drug placed into interstitial space
Diagnosis: pain and swelling
Potential problems: delayed absorption

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9
Q

Describe the prevention of extra vascular injection

A
  • Good canulation
  • test dose of saline in every cannula first
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10
Q

Describe the treatment for extra vascular injection

A
  • remove cannula
  • apply pressure
  • reassure
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11
Q

How do you get an intra-arterial injection

A

When you put the cannula into the brachial artery (it’s deep so unlikely to happen). Nb always stay superficial for veins

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12
Q

How would you diagnose an intra-arterial injection

A
  • pain on venepuncture
  • red blood in cannula
  • difficult to prevent leaks
  • pain radiating distally from site of cannulation
  • loss of colour or warmth to limb/weakening pulse
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13
Q

Prevention of intra arterial injection

A
  • avoid anatomically prone sites- ACF Medial to biceps tendon
  • palpate before attack
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14
Q

Management of intra arterial injection

A
  • monitor for loss of pulse (cold and discolouration)
  • leave cannula in situ for 5 mins post drug
  • no problems, remove and apply pressure
  • symptomatic, leave and refer to hospital (procaine 1%)
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15
Q

What is a Haematoma

A

Extravasating of blood into the soft tissues due to damage to vein walls (A big bruise)

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16
Q

How and when could a Haematoma occur in sedation

A

At venepuncture - poor technique
At removal of cannula - fail to apply pressure

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17
Q

Prevention of Haematoma

A
  • good cannulation technique
  • pressure post operative lay
  • care with the elderly
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18
Q

Treatment of Haematoma

A
  • time
  • rest
  • reassurance
  • if severe, initial ice pack
  • moist heat 20mins in an hour after 24hrs
  • consider heparin containing gel
19
Q

How can fainting during venepuncture happen

A
  • anxiety related to venepuncture. Worse if starved
20
Q

How to prevent fainting at venepuncture

A
  • don’t starve patients
  • topical skin anaesthesia
  • inhalation sedation first to relax them enough to get them cannulated
  • slightly supine position
  • find out first if they faint a lot/ anxious with needles
21
Q

What are the IV sedation complications of drug administration

A
  1. Hyper-responders
  2. Hypo-responders
  3. Paradoxical reactions
  4. Oversedation
  5. Allergic reactions
22
Q

Who is most likely to be a hyper responder

A

The elderly

23
Q

How do you identify a hyper-responder

A

Deep sedation with minimal dose (1-2mg midazolam)

24
Q

How do you prevent hyper-responder

A

Care with titration
- case for 1mg increments
- slow titration in elderly (e.g. 1/2mg and wait longer)

25
What is a hypo responder
Little sedative effect with large doses
26
Why might someone be a hypo-responder
- BZD induced (drug habit) - Cross tolerance - Ideopathic
27
What is your threshold to abandon with a hypo-responder
BNF says max dose 7.5mg (Don’t go over 10mg if you don’t think it’s working)
28
What is a paradoxical reaction
Appear to sedate normally, react extremely to all stimuli, relax when stimuli is removed
29
How do you manage a paradoxical reaction
Check for failure of LA Do NOT go on adding sedative Find other management technique Watch immature teenagers (more likely in 12-16 y/o)
30
What is the progression when you oversedate someone
1 Loss of responsiveness 2 Respiratory depression 3 Loss of ability to maintain airway 4 Respiratory arrest
31
What is the management of oversedation
1 stop procedure (check AVPU) 2 Try to rouse patient (shake pt/inflict pain) A B C If no response to stimulation and support - reverse with flumazenil 200µg then 100µg increments at minute intervals - watch for 1-4hours (due to half life) Be more careful next time
32
What is management of respiratory depression
- check the oximeter - stimulate patient (ask to breathe deeply) - supplemental oxygen (nasal cannulae 2 litres per minute) - reverse with flumazenil (if oxygen drops <90% and not coming back up again, you have to reverse)
33
How do you manage allergic reactions
Rare to sedatives - do not use flumazenil (it’s a benzodiazapine and so is the drug you just gave) - manage as if not sedated (IM adrenaline). Advantage of IV access
34
How do you manage the risk of patients having sexual fantasy
- no idea how to prevent - ensure chaperoned and there are 2 people in the surgery at all times
35
What are the complications of inhalation sedation
1. Oversedation (safety features on machine e.g. max dose of NiO) 2. Patient panics
36
How can oversedation with IS happen initially
Midjudge dose
37
How can oversedation with IS happen later in procedure
Once the traumatic procedure is over (e.g. only nervous about LA and then they relax but dose is not adjusted) Mouth breathing ceases
38
Most common sign of oversedation
Vomiting
39
Signs and symptoms of N2O overdose
- patient discomfort - lack of co-operation - mouth breathing - giggling - nausea - vomiting - loss of consciousness
40
Treatment of overdose (IS)
- decrease N2O concentration by 5-10% - reassure - don’t remove nose piece (put 100% O2 to prevent diffusion hypoxia)
41
What is diffusion hypoxia
Where N2O massive diffusion gradient There is more N2O in lungs than atmosphere, N2O rushes out into atmosphere but as it does, it prevents O2 getting in Keep nose piece on them after turning off for at least 3-5 mins
42
Why might a patient panic (IS)
- have you the correct sedation technique? - usually invasive procedures
43
How to cope with a patient panicking
- reassure (get their breathing going) - if cannot cope with sedation, abort (might need IV sedation or GA)

BDS4 Sedation (3 decks)

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