Complications of conscious sedation

Question 1

What drug is used to reverse midazolam and how much?

Answer 1

Flumazenil

2mg then 1mg in increments at minute intervals

Question 2

What are signs and symptoms of N2O overdose?

Answer 2

Patient discomfort
Lack of co-operation
Mouth-breathing
Giggling
Nausea
Vomiting
Loss of consciousness

Question 3

How do you treat overdose of inhalation sedation?

Answer 3

Decrease N2O concentration by 5-10%
Reassure
Don’t remove nosepiece - diffusion hypoxia
Then give pt O2

Question 4

What is venospasm?

Answer 4

• Disappearing vein syndrome
  
  • Veins collapse at attempted venepuncture
  • May be accompanied by burning
    Associated with poorly visible veins

Question 5

What happens in an extra-vascular injection and what is a potential problem with it?

Answer 5

Active drug placed into interstitial space
Pain and swelling
Potential problems - delayed absorption

Question 6

How do you manage extravascular injection?

Answer 6

Prevention
- Good cannulation
- Test dose of saline - flush with saline to check its flowing through veins

Treatment
- Remove cannula
- Apply pressure
- Reassure

Question 7

Signs/ symptoms intravascular/ arterial injection?

Answer 7

Pain on venepuncture
Red blood in cannula
Pain radiating distally from site of cannulation
Loss of colour or warmth to limb/ weakening pulse

Question 8

How to prevent of intravascular/ arterial injection?

Answer 8

Avoid anatomically prone sites
Palpate before attack

Question 9

How to manage intravascular/ arterial injection?

Answer 9

Monitor for loss of pulse - cold, discolouration.
Leave cannula in situ for 5 mins post-drug

If no problems - remove
Symptomatic leave & refer to hospital (procaine 1%)

Question 10

Why does a haematoma occur during cannulation?

Answer 10

Extravasation of blood into soft tissues
Due to damage to vein walls

Question 11

What is the average dose for sedation?

Answer 11

5-6mg

Question 12

What are some complications of IV sedation with drug administration?

Answer 12

Hyper-responders
Hypo-responders
Paradoxical reactions
Over sedation
Allergic reactions

Question 13

What is the threshold of max drug to abandon for hypo-responders?

Answer 13

10mg in GDP
15mg in hospital

Question 14

What is the distribution half-life of midazolam?

Answer 14

15 minutes

Question 15

What is the elimination half-life of midazolam?

Answer 15

1-2 hours

Question 16

What is the drug used inhalation sedation?

Answer 16

Nitrous oxide