Inhalation sedation

Question 1

Indications for inhalation sedation

Answer 1

Mild to moderate anxiety, needle phobia, gagging, traumatic procedure, medical conditions aggravated by stress, unaccompanied adult requiring sedation

Question 2

Contraindications for inhalation sedation

Answer 2

Common cold (blocked nasal airway), tonsillar/adenoidal enlargement, severe COPD, pregnancy, fear of mask/claustrophobia, inability to understand

Question 3

Signs of adequate sedation

Answer 3

• Patient relaxed/comfortable (feel bit dreamy/floaty)
  
  • Patient awake (and able to interact with you)
  • Reduced blink rate
  • Laryngeal reflexes unaffected
  • Vital signs unaffected
  • Gag reflex obtunded
  • Mouth open on request
  • Decreased reaction to painful stimuli
  • Decrease in spontaneous movements
  • Verbal contact maintained

Question 4

Symptoms of adequate sedation

Answer 4

• Mental and physical relaxation (exactly what we’re after)
• Lessened awareness of pain
• Paraesthesia - lips, fingers, toes, legs, tongue
• Lethargy/”a few pints”, “why your mum is less grumpy after a glass of wine”
• Euphoria
• Detachment ‘floating feeling’
• Warmth
• Altered awareness of passage of time
• Dreaming
Small controllable “fit of the giggles”

Question 5

Signs and symptoms of over sedation

Answer 5

• Mouth closing - repeatedly
  
  • Spontaneous mouth breathing
  • Nausea/vomiting
  • Irrational and sluggish responses
  • Decreased cooperation
  • Incoherent speech
  • Uncontrolled laughter, tears
  • Patient no longer enjoying the effects
  • LOC (loss of consciousness)

Question 6

Advantages of IS

Answer 6

• Rapid onset (2-3mins)
  
  • Rapid peak action (3-5mins)
  • Depth altered either way (turn sedation up or down pretty easily/quickly)
  • Flexible duration
  • Rapid recovery
  • No injection (for the sedation obviously LA still required depending on the procedure)
  • Few side effects to patient
  • Drug not metabolised
  • Some analgesia (though better for iscaemic than inflammatory pain) - fingers/toes could feel tingly/pins and needle/numb
  • No amnesia (might be happy to do without sedation in future as they will realise it wasn’t too bad as they can remember everything)

Question 7

Disadvantages of IS

Answer 7

• Equipment expensive
• Gases expensive
• Space occupying equipment
• Not potent (only just gives them final bit of courage for treatment, patient needs to want treatment, not enough to disarm someone who really doesn’t want it)
• Requires ability to breath through nose
• Chronic exposure risk?
• Staff addiction
Difficult to accurately determine actual dose (especially if nasal hood bit loose, patient starts talking etc)