Conscious Sedation

Question 1

1. What are preoperative considerations in eval for conscious sedation?

Answer 1

not in extremes of ages
NPO status
co-mobidities: morbid obesity, OSA, RA, smoking, COPD asthma

anticipated difficult airway
pregnancy or nursing
h/o drug or alcohol abuse,
mental illness

Question 2

2. Define conscious, deep and general sedation.

Answer 2

conscious: patients respond to verbal commands, maintain ventilatory and CV status
deep: responsive to only profound stimulus, require assistance in maintaining airway, CV maintained
general: unarousable with painful stimulus, limited reflex withdrawal, require airway support, may require CV support

Question 3

3. Discuss cases appropriate for conscious sedation and its risks.

Answer 3

appropriate: cataract, vein stripping, carpal tunnel, craniotomy, D&C, MRI
risks: airway desat, respiratory arrest, aspiration, hypotension, HTN, brady/tachy, cardiac arrest, allergic reaction

Question 4

4. List appropriate monitors and emergency equipment for conscious sedation.

Answer 4

EKG, blood pressure, O2 sat, respiration, +/- etCO2, temp oxygen

Question 5

5. Compare and contrast the mech of action and pharmokinetics of: midazolam

Answer 5

benzo, increases frequency of GABA channel opening (allows calcium inhibitory effect)

short acting, sedation, anxiolysis and amnesia but no analgesic

1-3mg, higher doses protracted effects and disinhibition

Question 6

5. Compare and contrast the mech of action and pharmokinetics of: flumazenil

Answer 6

benzo antagonist- used after ventilatory arrest

0.2 initial dose, short duration (30-60min)

potential for tachyphylaxis

Question 7

5. Compare and contrast the mech of action and pharmokinetics of: naloxine

Answer 7

opioid antagonist (reversal)

SE: pain, tachy, HTN **pulm edema

Question 8

5. Compare and contrast the mech of action and pharmokinetics of: proprofol

Answer 8

isopropylphenol sedative-hypnotic

not reliably amnestic (needs benzos), short acting

bronchodilator, anticonvulsant, anit-emetic

** precipitious hypotension 2/2 vasodilation

soy bean, egg white –> beware of allergies

Question 9

5. Compare and contrast the mech of action and pharmokinetics of: dexmedetomidine

Answer 9

highly selective alpha 2 agonist

short acting
continuous infusion for dose dependent sedation and analgesia with no significant depression of ventilation

SE: bradycardia, hypotension and hypothermia

Question 10

5. Compare and contrast the mech of action and pharmokinetics of: ketamine

Answer 10

dissociative anesthetic

amnestic and analgesic

no depression of ventilation, sympathetic driver and bronchodilator

emergence delirium

Question 11

6. Review appropriate discharge criteria for conscious sedation patients.

Answer 11

• have attendant
• SE: N, V HA, Dizziness
• specific written instructions
• various discharge, none based in fact