Complications of Conscious Sedation Flashcards
What is used in inhalation sedation?
Nitrous oxide
What is used in IV sedation?
Midazolam
What is the reversal drug for midazolam?
Flumazenil
What are the most common complications of IV sedation?
Venospasm
Extravascular injection
Intraarterial injection
Haematoma
Fainting
What is venospasm?
Disappearing vein syndrome
Veins collapse at attempted venepuncture
May be accompanied by burning
Associated with poorly visible veins
What is the management of venospasm?
Time dilating vein
-worse with repeated attempts
Efficient technique
-slow skin puncture makes worse
Warm water/gloves in winter
What is extravascular injection?
Diagnosis?
Active drug placed into interstitial space
Drug sits in the hand and does not disperse properly, delayed absorption
Diagnosis- pain & swelling
What is the management of extravascular injection?
Prevention
–good cannulation
–test dose of saline- flush
Treatment
–remove cannula, apply pressure & reassure
What is the diagnosis of intra-arterial injection?
Pain on venepuncture
Red blood in cannula
Difficult to prevent leaks
Pain radiating from site of cannulation
Loss of colour or warmth to limb/weakening pulse
What is the management of intra-arterial injections?
Monitor for loss of pulse
–cold and discoloured
Leave cannula in situ for 5 minutes post drug
No problems- remove
Symptomatic leave & refer to hospital
What is a haematoma?
Extravasation of blood into soft tissues
Due to damage to vein walls
How can you prevent a haematoma from occurring?
Good cannulation technique
Pressure post operatively
Care with the elderly
What is the treatment of a haematoma?
Time
Rest
Reassurance
If severe
–ice pack
–moist heat 20 mins in hour after 24hrs
Consider heparin containing gel
What is the threshold of mg of midazolam to abandon sedation?
Dental care setting?
Hospital setting?
Dental care setting- 10mg
Hospital setting- 15mg
What are some complications of drug administration with IV sedation?
Hyper-responders
Hypo-responders
Parodoxical reactions
Oversedation
Allergic reactions
What is a parodoxical reaction to drug adminstration?
Appear to sedate normally
React extremely to all stimuli
Relax when stimuli is removed
Check for failure of LA
Do not continue adding sedative
What does oversedation cause?
Loss of responsiveness
Respiratory depression
Loss of ability to maintain airway
Respiratory arrest
What is the management of oversedation?
Stop procedure
Try to rouse patient
ABC
If no response to stimulation and support
–reverse with flumazenil
–watch for 1-4 hours
What is the management of respiratory depression?
Check the oximeter
Stimulate patient (encourage to breath)
Supplemental oxygen
–nasal cannulae 2 litres per minute
–if no improvement, stop treatment and 15 litres per minute non rebreathing mask
Reverse with flumazenil if no improvement
What are the common complications of inhalation sedation?
Oversedation
Patient panics
What are the signs and symptoms of nitrous oxide overdose?
Patient discomfort
Lack of co-operation
Mouth breathing
Giggling
Nausea
Vomiting
Loss of consciousness
What is the treatment for nitrous oxide overdose?
Decrease nitrous oxide concentration by 5-10%
Reassure
Don’t remove nosepiece (diffusion hypoxia)
