Complications of Sedation Flashcards
What are the common complications of cannulation in IV sedation?
Venospasm
Extravascular injection
Intra-arterial injection
Haematoma
Fainting
What is venospasm and what is the management of it?
Veins collapse at attempted venipuncture- may be accompanied by burning.
Management
- warm water/gloves to heat up the hand.
- Time dilating veins- be quick when cannulating.
What is an extravascular injection and how is is managed?
Active drug placed into the interstitial space rather than the vein- will cause pain and swelling.
Prevention- good cannulation, test dose of saline.
Treatment- remove cannula, apply pressure and reassure.
What is an intra-arterial injection and what is the management of it?
Sedative is injected into an artery instead of a vein
- pain on venepuncture, red blood in cannula, pain radiating distally from site of cannulation, loss of colour or warmth in limb.
Prevention- avoid anatomically prone sites- ACF medial to biceps tendon.
Management
- monitor for loss of pulse
- Leave cannula in situ for 5 mins post drug- remove if no problems.
- If symptomatic leave and refer to hospital.
Describe a haematoma and the prevention/management strategies?
Extravasation of blood into tosses due to damage of the vein walls.
Prevention- apply pressure when taking the cannula out, apply pressure once it is out, good cannulation technique.
Treatment- time, rest and reassurance.
If severe- apply ice pack, moist heat 20 minutes in hour after 24 hours.
Consider heparin containing gel.
How can you avoid fainting during venepuncture?
Ensure the patient has eaten something prior to cannulation
Don’t let the patient see you cannulate them
Use topical skin anaesthesia
Treatment- lay the patient flat, legs in the air, plenty air in the room.
What are the potential complications of IV sedation?
Hyper-responders
Hypo-responders
Paradoxical reactions
Oversedation
Allergic reactions
What does it mean if a patient is a hyper-responder to IV sedation?
Deep sedation with minimal dose- 1-2mg of midazolam.
Slow titration is required.
What does it mean if a patient is a hypo responder to IV sedation?
Little sedative effect with large doses of midazolam.
May be due to tolerance- regulary taking BZD, methadone users, idiopathic.
What does it mean if a patient has a paradoxical reaction to IV sedation?
Appear to sedate normally but react extremely to all stimuli and then relax when stimuli removed.
Management- check for failure of LA first, do not give any more sedative.
What does it mean if a patient is oversedated?
loss of responsiveness
Loss of consciousness
Respiratory depression- oxygen saturation decreasing
Loss of ability to maintain airway
Respiratory arrest
What is the management strategies for over sedation?
Stop procedure
Try to rouse the patient
Perform medical emergency checks- ABCDE
If no response to stimulation and support
- reverse with flumazenil- 200 micrograms and then 100microgram increments every minute.
- Watch for 1-4 hours.
If the patient’s oxygen saturation starts to fall, what would you do?
Check the oximeter
Ask the patient to take deep breathes in and out- check that the oximeter goes up.
Give supplemental oxygen- nasal cannulae 2 litres per minute.
- then consider a non-rebreathing mask at 15 litres per minute.
Reverse with flumazenil- 200 micrograms and then 100 micrograms every minute.
If someone has an allergic reaction, why would you not give them flumazenil?
Flumazenil is also a BZD. Treat it as an allergic reaction- 0.5mg of adrenaline.
Why must you be chaperoned during a sedation appointment?
There is a risk of sexual fantasy.
