Conscious Sedation Flashcards
What is the intent of procedural sedation and analgesia?
Depressed level of consciousness that allows patient to maintain oxygenation and airway control independently
Goals of conscious sedation
- Minimize pain
- Alleviate anxiety
- Maximize amnesia
- Control behavior
- Maintain CV and resp status
Define anxiolysis
- Minimal sedation
- Response to verbal stimulation is normal
- Cognitive function and coordination may be impaired
- CV and resp functions unaffected
What drug is MC used for procedural sedation and analgesia?
Versed (Midazolam)
What is the reversal agent of Versed (Midazolam)?
Flumazenil
Cons of Versed (Midazolam)
- No analgesia
- Resp depression
- Hypotension w/high doses
- Disinhibition
What drug is MC used for mild-mod sedation?
Lorazepam (duration of action is longer than Midazolam)
Define moderate (conscious) sedation
- Drug induced depression of consciousness
- Pt responds purposefully to verbal commands
- Airway is patent, spontaneous ventilation adequate
- CV function usually unaffected
Define deep sedation
- Pt responds purposely following repeated/painful stimulation
- Independent maintenance of vent function may be impaired
- Spontaneous ventilation may be inadequate
- CV function usually maintained
Define general anesthesia
- Drug induced loss of consciousness
- Pt cannot be aroused
- Ventilatory function is impaired
- CV function may be impaired
Risks of sedation
- Hypotension
- Hypoxia
- Bradycardia
- Cardiac dysrhythmias
- Respiratory depression
Pros of Versed (Midazolam)
- Decent amnesia
- Has a reversal agent
How does lorazepam compare to midazolam for sedation?
- Onset is slower than midazolam
- Duration is LONGER (6-8 hrs vs. 30-60 mins)
- Double the potency of midazolam
Pros of Ketamine
- Analgesia/amnesia
- Airway reflexes maintained
- No pain perception
- Dosing IM, IV, PO, PR
Cons of Ketamine
- Sympathomimetic
- Increased ICP, IOP and BP
- Laryngospasm
- Emesis
- Emergence reaction
- Increases muscle tone
- Patient will still move
Describe Etomidate
- Ultra short acting non-barbiturate hypnotic used for anesthesia
- Works via GABA receptors
- Produces rapid induction without histamine release and w/minimal CV/respiratory effects
Pros of Etomidate
- Quick on and off
- No histamine release
- Minimal CV/resp effects
- Possible amnesia
Cons of Etomidate
- Myoclonus
- NV
- No analgesia
- 12-48 hrs inhibition of adrenal axis
Describe Propofol
- Potent ultra short acting sedation and anesthesia
- MOA unknown (GABA?)
- NO analgesic properties
What are the ultra short acting drug options for sedation?
- Etomidate
- Propofol
Pros of Propofol
- Quick on and off
- Antiemetic
- Amnesia
- Anticonvulsant
- Decreases ICP and IOP
Cons of Propofol
- Burns during injectino
- No analgesia
- Hypotension
- Decreased resp drive
- Allergic reaction to soy and eggs possible
Role of opiates in procedures?
Provides analgesia and sedation
What is the usual opiate of choice in procedures/sedation?
Fentanyl (prompt onset and short duration w/minimal CV/resp effects)
