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
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.
3
Q
VOCAB LACK OF ..... FOR ANESTHESIA ANALGESIA AMNESIA ANXIOLYSIS
A
FEELING
PAIN
MEMORY
ANXIETY
4
Q
TYPES OF PROCEDURES (10)
A
- ENT - vocal cord injections / eustatian tubes
- opthalmic: cararact extraction / trabeculectomy, ptsosis surgery
- endoscopy
- plastic procedures: dermatology , biopsy, lumpectomy
- GYN: (EUA’s)
- orthopedic: fracture reduction, hand/food procedure, joint replacement
- general procedures: wound debridement, J/G-tube placement
- Pain procedure: image guided steroid injection
- imaging: MRI, CT scan
- Radiation
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
6
Q
PATIENT HISTORY COMPONENTS
A
medications physical limitations NPO status past procedures consult records past anesthesia success / problems / notes
7
Q
CONSENT SHOULD INCLUDE A THOROUGH EXPLANATION OF CONSCIOUS SEDATION (4)
A
- possibility of transient sensations of pain or awareness
- sedation can be increased and/or converted to general anesthesia
- the procedure will not continue if pain or awareness persists and can not be controlled with conscious sedation
- the patient will be monitored prior / during / after the procedure by qualified healthcare personel
8
Q
THINGS TO PREPARE FOR ANESTHESIA (4) & FOR THE PATIENT (3)
A
- Monitors: BP, HR, SpO2, ETCO2
- Oxygen: nasal prong, face mask, head strap
- Resuscitation equipment (ETT, ambu bag, defibrillator, emergency drugs, naloxone, flumazenil)
- IV pump: for sedation med drips
- consent
- IV acess
- introduce personel
9
Q
MEDICATION PLAN (3)
A
- choose appropriate sedative/narcotics appropriate for length & physical needs of procedure
- Possible types of drugs
sedatives / analgesics / systemic agents - know if will be supplementing a regional block or if your sedation will be the only anesthetic administered
10
Q
POSSIBLE MEDS (10)
A
- fentanyl (sublimaze)
- remifentanil
- sufentanil
- versed (midazolam)
- meperidine (demerol)
- morphine
- ketamine
- flumazenil
- naloxone
- propofol ( diprovan)
11
Q
POSSIBLE MEDS
OPIOID AGONIST (5) -
produces analgesia & anesthesia
-SIDE EFFECTS
A
- fentanyl
- remifentanly
- sufentanyl
hypTN, brady, resp dep, apena, N/V,
muscle rigidity, pruritus - meperidine (demerol)
hypoTN, resp dep, cardiac arrest, seizures,
muscle rigidity, pruritius
DO NOT GIVE WITH MAOI - morphine
hypoTN, brady, arrhythmia, chest wall rigidity, bronchospasm, laryngospasm, N/V, pruritus
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
13
Q
POSSIBLE MEDS
BENZODIAZEPINE
-sedation & hypnosis
SIDE EFFECTS
A
Midazolam - versed
- resp dep (esp if w/ opioids)
- tachy
- hypoTN
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
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
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
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PROCEDURES
PLASTICS
PRECAUTIONS
-ensure good candidate for... b/c...
-what kind of agents use & why
-why consider using anti-emetics
```
- 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
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PROCEDURES
MRI/CT SCAN
-drugs
-why need sedation
-secure what
-what may need to be repeated if procedure is interrupted
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- midazolam, propofol (drip)
- anxiety & comfort during lengthy CT scans/nosie of MRI
- safe & efficient airway
- secure safe & efficient airway
27
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PROCEDURES
MRI/CT SCAN
PRECAUTIONS
-tubing
-monitors
-equipment ready for
```
- long enough while table moving in/out
- visible to you as provider in viewing room
- GA (including MRI compatible machine/equip)
28
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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
```
- 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
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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
```
- 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
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
- appropriate candidate
- MAC & GA
- length & needs of each procedure
- calm, confident, honest
- emergency
