Complications of conscious sedation Flashcards
What is the most common form of conscious sedation
IV
What are the complications of cannulation
Venospasm
Extravascular injection
Intra-arterial injection
Haematoma
Fainting
What is venospasm
Dissapearing vein syndrome
Veins collapse at attempted venepuncture
May bee accompanied with burning
How to manage venospasm
time dilating vein- worst with repeated attempts
Slow skin punctures makes it worst
What is extravascular injection
Active drug is placed into interstitial space
pain and swelling and may lead to delayed absorption
How do you manage extravascular injection
Prevention
-Good cannulation
-Test dose of saline
Treatment
-Remove cannula
-Apply pressure
-Reassure
What is the diagnosis for intra-arterial injection
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
What is the management of intra-arterial injection
Prevention
-Avoid anatomically prone sites- ACF Medial to biceps tendon
-Palpate before attack
-Avoid minjecting medially
Management
-Monitor for loss of pulse
-Leave cannula in situ for 5 mins post drug
-No problems – remove
-Symptomatic leave & refer to hopspital (procaine 1%)
What is a haematoma
Extravasation of blood into soft tissues
Due to damage to vein walls
At venepuncture
Poor technique
Removal of cannula
What are the complications of IV sedation
Hyper-responders
Hypo-responders
Parodoxical reactions
Oversedation
Allergic reactions
What happens with IV sedation hypo responders
Deep sedation with minimal dose
-1-2mg midazolam
Care with titration
-Case for 1mg increments
-Slow titration in elderly
What happens with IV sedation hypo responders
Little sedative effect with large doses
Check cannula in vein
May be due to tolerance
What are the max doses of Midazolam
15mg in hspital setting
10mg practise setting
What happens with IV sedation paradoxical reactions
They dont sedate
What happens in over sedation
Loss of responsiveness
Respiratory depression
Loss of ability to maintain airway
Respiratory arrest
