Complications of Conscious Sedation

Question 1

what drug is used in IHS

Answer 1

nitrous oxide

Question 2

what drug is used in IVS

Answer 2

midazolam

Question 3

what is conscious sedation

Answer 3

a technique in which the use of a drug or drugs produces a state of depression of CNS

Question 4

what complications can arise from cannulation

Answer 4

venospasm
extravascular injection
intraarterial injection
haematoma
fainting

Question 5

what is venospasm

Answer 5

where the veins collapse at attempted venepuncture

Question 6

how do you manage venospasm

Answer 6

take time to dilate the vein (with tourniquet and gravity)
use efficient technique
wear gloves in winter (for patient before they come in)

Question 7

what is extravascular injection

Answer 7

where the active drug is placed into interstitial space

Question 8

how do you diagnose extravascular injection

Answer 8

if there is pain and swelling present

Question 9

what is the problem associated with extravascular injection

Answer 9

delayed absorption

Question 10

how do you manage extravascular injection

Answer 10

prevent by good cannulation and saline wash
treat by removing cannula, applying pressure and reassuring patient

Question 11

how do you diagnose intra-arterial injection

Answer 11

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

Question 12

how do you prevent intra-arterial injection

Answer 12

avoid anatomically prone sites
palpate before

Question 13

how do you manage intra-arterial injection

Answer 13

monitor for loss of pulse
leave cannula in situ for 5 mins post drug
remove if no issues
if symptomatic refer to hospital

Question 14

what is a haematoma

Answer 14

extravasation of blood into soft tissues due to damage to vein walls

Question 15

when does haematoma occur

Answer 15

at venepuncture due to poor technique
removal of cannula if fail to apply pressure

Question 16

who is more prone to haematoma

Answer 16

elderly

Question 17

how do you prevent a haematoma from occurring

Answer 17

good cannulation technique
pressure post operatively
take care with elderly

Question 18

how do you treat a haematoma

Answer 18

time
rest
reassurance
if severe - ice pack

Question 19

why do people faint during sedation

Answer 19

anxiety related to venepuncture
not eaten

Question 20

how do you prevent fainting

Answer 20

dont starve patient
topical skin anaesthesia first to calm them
position patient sitting down

Question 21

what are the complications of drug administration

Answer 21

hyper-responders
hypo-responders
paradoxical reactions
oversedation
allergic reactions

Question 22

what are hyper-responders

Answer 22

people who are deeply sedated with minimal dose (1-2mg midazolam)

Question 23

how do you deal with hyper-responders

Answer 23

take care with titration
give 1mg increments
titrate slowly in elderly

Question 24

what is a hypo-responder

Answer 24

little sedative effect with large doses

Question 25

how do you deal with a hyporesponder

Answer 25

check cannula is in vein abandon at certain threshold

Question 26

what type of people could be hyporesponders

Answer 26

benzodiazepine users who have built up a tolerance

Question 27

what is a paradoxical reaction

Answer 27

appear to sedate normally but actually are not sedated these people react extremely to all stimuli

Question 28

how do you manage a paradoxical reaction

Answer 28

check for failure of LA dont add more sedative find other management techniques

Question 29

what is oversedation

Answer 29

loss of responsiveness respiratory depression/arrest

Question 30

how do you manage oversedation

Answer 30

stop procedure try to rouse patient ABC if no response to stimulation and support reverse with flumazenil 200ug and then 100ug increments at minute intervals watch for 1-4hrs

Question 31

how do you manage respiratory depression

Answer 31

check oximeter stimulate patient and ask to breathe give supplemental oxygen through nasal cannula reverse with flumazenil

Question 32

how much oxygen is given to a patient through a nasal cannula

Answer 32

2l per min

Question 33

how do you manage an allergic reaction to midazolam

Answer 33

DO NOT USE FLUMAZENIL use adrenaline IM

Question 34

how do you manage incidences of sexual fantasy with sedated person

Answer 34

ensure the patient is chaperoned at all times

Question 35

what are the complications of inhalation sedation

Answer 35

oversedation patient panics

Question 36

how can oversedation occur in IHS

Answer 36

misjudge the dose procedure is over but mouth breathing ceases

Question 37

what are the signs and symptoms of N2O overdose

Answer 37

patient discomfort lock of co-operation mouthbreathing giggling nausea vomiting loss of consciousness

Question 38

how do you treat N2O overdose

Answer 38

decrease N2O concentration by 5-10% reassure do not remove nosepiece

Question 39

if you remove a nosepiece from someone who is oversedated with IHS what can happen

Answer 39

diffusion hypoxia

Question 40

how do you deal with a patient who panics from IHS

Answer 40

reassure if they cannot cope then abort