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PRINCIPLES > CONSCIOUS SEDATION > Flashcards

CONSCIOUS SEDATION Flashcards

1
Q

VOCAB

What is conscious sedation

A

anesthesia providing a decreased level of awareness or altered state of consciousness; while maintaining the patients ability to use their airway reflexes & provide adequate ventilation for themselves

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2
Q

Goal of conscious sedation

A

to provide analgesia, amnesia, & anxiolysis for patients who are undergoing uncomfortable, painful, stressful, or lengthy procedures requiring minimal movement.

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3
Q 
VOCAB
LACK OF ..... FOR
ANESTHESIA
ANALGESIA
AMNESIA
ANXIOLYSIS
A

FEELING
PAIN
MEMORY
ANXIETY

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4
Q

TYPES OF PROCEDURES (10)

A
  1. ENT - vocal cord injections / eustatian tubes
  2. opthalmic: cararact extraction / trabeculectomy, ptsosis surgery
  3. endoscopy
  4. plastic procedures: dermatology , biopsy, lumpectomy
  5. GYN: (EUA’s)
  6. orthopedic: fracture reduction, hand/food procedure, joint replacement
  7. general procedures: wound debridement, J/G-tube placement
  8. Pain procedure: image guided steroid injection
  9. imaging: MRI, CT scan
  10. Radiation
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5
Q

THINGS TO TALK TO SURGEON ABOUT (3)

A

ASA status - I, II, III
Procedure length, potential pain level, positioning
Does patient need to be verbal

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6
Q

PATIENT HISTORY COMPONENTS

A 
medications
physical limitations
NPO status
past procedures
consult records
past anesthesia success / problems / notes
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7
Q

CONSENT SHOULD INCLUDE A THOROUGH EXPLANATION OF CONSCIOUS SEDATION (4)

A
  1. possibility of transient sensations of pain or awareness
  2. sedation can be increased and/or converted to general anesthesia
  3. the procedure will not continue if pain or awareness persists and can not be controlled with conscious sedation
  4. the patient will be monitored prior / during / after the procedure by qualified healthcare personel
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8
Q

THINGS TO PREPARE FOR ANESTHESIA (4) & FOR THE PATIENT (3)

A
  1. Monitors: BP, HR, SpO2, ETCO2
  2. Oxygen: nasal prong, face mask, head strap
  3. Resuscitation equipment (ETT, ambu bag, defibrillator, emergency drugs, naloxone, flumazenil)
  4. IV pump: for sedation med drips
  5. consent
  6. IV acess
  7. introduce personel
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9
Q

MEDICATION PLAN (3)

A
  1. choose appropriate sedative/narcotics appropriate for length & physical needs of procedure
  2. Possible types of drugs
    sedatives / analgesics / systemic agents
  3. know if will be supplementing a regional block or if your sedation will be the only anesthetic administered
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10
Q

POSSIBLE MEDS (10)

A
  1. fentanyl (sublimaze)
  2. remifentanil
  3. sufentanil
  4. versed (midazolam)
  5. meperidine (demerol)
  6. morphine
  7. ketamine
  8. flumazenil
  9. naloxone
  10. propofol ( diprovan)
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11
Q

POSSIBLE MEDS
OPIOID AGONIST (5) -
produces analgesia & anesthesia
-SIDE EFFECTS

A
  1. fentanyl
  2. remifentanly
  3. sufentanyl
    hypTN, brady, resp dep, apena, N/V,
    muscle rigidity, pruritus
  4. meperidine (demerol)
    hypoTN, resp dep, cardiac arrest, seizures,
    muscle rigidity, pruritius
    DO NOT GIVE WITH MAOI
  5. morphine
    hypoTN, brady, arrhythmia, chest wall rigidity, bronchospasm, laryngospasm, N/V, pruritus
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12
Q

POSSIBLE MEDS
NMDA RECEPTOR ANTAGONIST
-produces anesthesia/dissociative anesthesia
SIDE EFFECTS

A

Ketmaine

  • dilerium/hallucination
  • minimal effect on resp dep
  • inc or maintain cardiac output
  • tachycardia / HTN
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13
Q

POSSIBLE MEDS
BENZODIAZEPINE
-sedation & hypnosis
SIDE EFFECTS

A

Midazolam - versed

  • resp dep (esp if w/ opioids)
  • tachy
  • hypoTN
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14
Q

POSSIBLE MEDS
INDUCTION AGENT
-produces anesthesia (facilitate inhibition of neurotransmission mediated by GABA)
SIDE EFFECTS

A

Propofol

  • hypoTN, brady, resp dep
  • vivid dreams
  • hiccups
  • burning on injection
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15
Q

POSSIBLE MEDS
OPIOID ANTAGONIS
-opiate reversal
SIDE EFFECTS

A

DOA may be shorter than duration of action of opioid

  • tachy
  • HypoTN
  • arrhythmia
  • pul edema
  • N/V
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16
Q

POSSIBLE MEDS
BENZO RECEPTOR ANTAGONIST
SIDE EFFECTS

A

DOA may be shorter than DOA of benzo

  • arrhythmia
  • tachy
  • HTN
  • angina
  • seizures
  • agitation
  • N/V
17
Q 
PROCEDURES
OPTHALMIC
-duration
-blood loss
-outpt or inpt
-blocks & for what
-drugs
-atropine for...
A
  • short
  • minimal
  • retrobulbar / peribulbar - anesthesia/ akenesia
  • outpatient
  • fentanyl, midazolam, propofol
  • to treat oculocardiac reflex
18
Q 
PROCEDURES
OPTHALMIC
-why thorough pre-op necessary
-why explain plan to pt
-which drug should be used in caution in ederly patients
-bed position
-what drug is needed for block placement
-why LESS IS MORE
A
  • ederly pts w/ significant med history
  • to avoid intra-op anxiety w/ minimal sedation
  • midazolam
  • 90 degress so ensure efficient airway before sedation & draping
  • propofol bolus
  • no movement tolerated & therefore less sedation = more pt awareness = prevention of involuntary movements
19
Q 
PROCEDURES
OPTHALMIC
PRECAUTIONS (3)
-explain OCR
-avoid\_\_ since may take 4 hrs
-why need to treat hypoxia early
A
  • caused by traction on extraocular muscles or putting pressure on eyeball
  • consists of trigeminal afferent and vagal efferent pathway
  • present as bradyc, vent ectopy, sinus arrest
  • Tx=stop or atropine (10mcg/kg)
  • excess of fluid to prevent bladder distention
  • b/c there will be decrease in lung reserve due to decreased tidal volumes under sedation
20
Q 
PROCEDURES
ORTHOPEDIC
-sedation done in conjunction with ...
-drugs used
-if block adequate then use...
-if block inadequate then use...
-what is best kinds of agents for manipulation (closed reductions) & how give them
A
  • regional/local blocks
  • fentanyl, midazolam, propofol
  • propofol drip at low doses
  • narcotics
  • small boluses fo short acting agents
21
Q 
PROCEDURES
ORTHOPEDIC
PRECAUTIONS
-what consider when release tournaquet
-what side effects monitor
-what need to continually check
-what need to have all equipment ready for
A
  • tournaquet pain and effect of lactic acid release
  • blocks (phrenic nerve block, high spinal)
  • position of pt, esp during fracture reductions where pulling & manipulation
  • GA
22
Q 
PROCEDURES
GENERAL SURGERY / ENDOSCOPY
-how long
-what need to provide for pt
-drugs
-what need to do prior to administration of sedation
A
  • short - so need short acting agents
  • pt comfort while minimizing pt mvment
  • fentanyl, midazolam, propofol(drip)
  • pt in position
23
Q 
PROCEDURES
GENERAL SURGERY / ENDOSCOPY
PRECAUTIONS
-what are pts at high risk for
-why need thorough medical history
-what about GYN procedures
-what need to have all equipment ready for
A
  • aspiration during endoscopy due to underlying disease & insulflation of air/fluids into stomach
  • pts receiving a G/J tube or would debridement often have a complicated / acute / long-term health hisotry & may be taking other synergistic meds
  • will be sedated in same manner but may require narcotics
  • GA
24
Q 
PROCEDURES
PLASTICS
-drugs
-what need to secure
-what kind of pre-op info need from pt
A
  • fentanyl, midazolam, propofol
  • airway/ventilation
  • home meds = diet pills / herbal meds
25
Q 
PROCEDURES
PLASTICS
PRECAUTIONS
-ensure good candidate for... b/c...
-what kind of agents use & why
-why consider using anti-emetics
A
  • MAC b/c access to face/airway may be very limited including post-op care
  • short acting meds b/c procedure may be short
  • to avoid strain on sutures during vomiting
26
Q 
PROCEDURES
MRI/CT SCAN
-drugs
-why need sedation
-secure what
-what may need to be repeated if procedure is interrupted
A
  • midazolam, propofol (drip)
  • anxiety & comfort during lengthy CT scans/nosie of MRI
  • safe & efficient airway
  • secure safe & efficient airway
27
Q 
PROCEDURES
MRI/CT SCAN
PRECAUTIONS
-tubing
-monitors
-equipment ready for
A
  • long enough while table moving in/out
  • visible to you as provider in viewing room
  • GA (including MRI compatible machine/equip)
28
Q 
PROCEDURES
ENT
-drugs
-thorough ...exam
-equipment ready if 
-why need extra bolus of meds
-why coach pt to cough
-why suction during procedure
-why consider antiemetics
A
  • fentanyl, midazolam, propofol
  • airway
  • difficult airway
  • more than one direct laryngoscopy may be peformed by surgeons
  • possible post-op blood in airway
  • to avoid aspiration if heavily sedated
  • blood swallowed may cause N/V
29
Q 
PROCEDURES
PAIN
-drugs
-what need to note during med history
-why need to consult with surgeon
- why need pt in position necessary for procedure prior to sedation
A
  • fentanyl, midazolam, propofol
  • when last took pain meds, dose, & next dose
  • if pt needs to give verbal feedback during procedure
  • to ensure comfort & relief of position associated pain
30
Q

IN CONCLUSION

  • make sure pt is __ __
  • prepare equip for __ & __
  • make sedation plan based on __ & __ of ___
  • communicate with pt in__, __, __ manner
  • have__equipment available for ALL procedures
A
  • appropriate candidate
  • MAC & GA
  • length & needs of each procedure
  • calm, confident, honest
  • emergency

PRINCIPLES (5 decks)

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