Guidelines for monitoring/management of sedation article

Question 1

What are the goals of sedation?

Answer 1

Guard pt safety and welfare
Minimize physical discomfort and pain
Control anxiety, minimize psychological trauma
Modify behavior for safe treatment

Question 2

How to select sedation drugs and dosage?

Answer 2

The lowest possible dose and type that will achieve results needed to complete treatment.
Need to know each drugs time of onset, peak response and duration of action

Question 3

Chloral Hydrate dosage for peds patients?

Answer 3

10-25mg/kg

Question 4

Herbal medication that affect pharmacokinetics?

Answer 4

Herbal meds that inhibit cytochrome P450 
-St Johns Wort
-Ginko, 
-Ginger, 
-ginseng, 
-Garlic 
Drugs that inhibit cytochrome P450
-Erythromycin 
-Cimetidine 

Kava may increase effects of sedatives by potentiating g-aminobutyric acid inhibition neurotransmission and increase acetominophene liver toxicity.

Question 5

Sedation health history evaluation?

Answer 5

Age
Weight 
food/medication allergies 
Medication/drug use (dosage, uses, and route of administration) 
Diseases 
Pregnancy status
History of prematurity 
History of seizure 
Hospitalization 
History of sedation/GA
Family history of anesthesia reactions

Question 6

Discharge qualifications?

Answer 6

Child’s level of consciousness and oxygen saturation on room is at a state for safe discharge.
-Remain awake for at least 20 minutes when placed in quiet room

Question 7

S.O.A.P. M.E. acronym

Answer 7

S-size appropriate suction catheters
O-an adequate oxygen supply 
A-size appropriate airway equipment 
P-pharmacy (drugs on hand for rescue)
M-monitors 
E-special equipment or drugs (defibrillator)

Question 8

What are the special considerations for sedation of former pre-term infants?

Answer 8

Immaturity of hepatic and renal function may alter ability to metabolize and excrete sedation medications resulting in prolonged sedation
Also an increased risk for post sedation apnea

Question 9

Treatment for Local anesthetic toxicity

Answer 9

1) get help
2) Resuscitation: CPD
3) seizure management- midazolam 0.1-.2mg/kg
4) 1.5mg/kg 20% lipid emulsion over 1 minute. Repeat twice if needed
5) initiate 20% lipid emulsion 0.25mg/kg per minute until circulation restored. Double if BP remains low. Continue for 10 minutes after attaining circulation stability
6) 10-20ml/kg balanced salt solution w/infusion phenylephrine 0.1ug/kg per minute.

Question 10

Treatment of laryngospasm?

Answer 10

1) positive pressure ventilation
2) Deepen sedation (propofol)
3) call for help
4) give muscle relaxant (succinylcholine + atropine)
5) Tracheal intubation
6) surgical airway

Question 11

Treatment of apnea?

Answer 11

1) bag/mask ventilation
2) reposition airway
3) perform jaw thrust
4) insert oral airway
5) call for help
6) insert nasal trumpet
7) insert supraglottic device (LMA
8) tracheal intubation
9) surgical airway