- INHALED ANALGESIA / PROCEDURAL SEDATION -

Question 1

Identify the indications for the clinical application of nitrous oxide

Answer 1

• any painful procedure (including wound management and IV insertion)
• distress surrounding short procedures

Question 2

Identify the possible complications related to the use of nitrous oxide

Answer 2

• over sedation
• respiratory depression
• nausea/vomiting
• hallucinations/confusion
• nitrogen narcosis
• increased risk with over 50:50 N to O2

Question 3

Identify the indications for procedural sedation

Answer 3

• Reduction of fractures/dislocations
• Incision and drainage of abscess
• Foreign body removal
• Electrical cardioversion
• Suturing in children

Question 4

Identify the contraindications for procedural sedation

Answer 4

• ACS
• Chest injuries
• Trapped gas (bowel obstruction, sinusitis)
• Acute respiratory conditions
• Cardiac disease

Question 5

List the equipment required for procedural sedation of and adult/paediatric

Answer 5

• Team
• Airway Equipment + plans B and C
 - BVM, Suction, Triple airway maneuver
• Monitoring (incl. ETCO2, and 5 min cycling)
• Pharmaceuticals
• Patient education
• Plus any extras (e.g. plaster)

Induction agents:
Ketamine 1.5-2 mg/kg 
Fentanyl 2-10 mcg/kg 
Midazolam 0.1-0.3 mg/kg 
Propofol 1-2.5 mg/kg

Question 6

Outline the procedure including patient education related to the administration of procedural sedation

Answer 6

• assessment of environment
• assessment of patients
• all staff prepared and present
• administration of fentanyl/midaz
• administration of propofol
• assessment of level of sedation
• procedure performed
• monitoring of sedation, abc, and airway support
• recovery and discharge

Question 7

Identify possible complications related to the administration of procedural sedation

Answer 7

• under/over sedate
• unprepared (equipment, people, time,etc)
• loss of airway
• hypotension
• vomiting
• bradycardia

Question 8

Identify the drugs used in your department for procedural sedation and list the side effects

Answer 8

Ketamine 1.5-2 mg/kg 
 - hypertension
 - tachycardia
 - hypersalivation
 - laryngospasm
Fentanyl 2-10 mcg/kg 
 - respiratory depression
 - vomiting
Midazolam 0.1-0.3 mg/kg 
 - hypotension
 - respiratory depression/apnoea
Propofol 1-2.5 mg/kg 
 - pain on injection
 - apnoea
 - hypotension