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BDS4 sedation symposium > intravenous sedation > Flashcards

intravenous sedation Flashcards

1
Q

what are features of an ideal IV sedation agent

A
  • anxiolytics
  • sedation
  • ease of administration
  • non-irritant
  • quick onset
  • quick recovery
  • no side effects
  • amnesia
  • low cost
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2
Q

what is the action of benzodiazepines

A
  • acts on receptors in the CNS to enhance the effect of GABA = prolongs time for receptor repolarisation
  • mimics effect of glycine (similar to GABA but on brainstem and spinal cord) on receptors = inhibitory neurotransmitter
  • all BZD’s have benzene ring allowing attachment to receptors
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3
Q

what is GABA

A
  • inhibitory CNS neurotransmitter in cerebral cortex and motor circuits
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4
Q

what are the respiratory effects of IV sedation

A
  • CNS depression nd muscle relaxation
  • decrease cerebral response to increased CO2
  • synergistic relationship with other CNS depressants
  • increased respiratory depression in already compromised pts
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5
Q

cardiovascular effects of IV sedation

A
  • decrease BP by muscle relaxation decreased vascular resistance
  • increased HR due to barareceptor reflex compensation for BP fall
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6
Q

what are side effects of IV sedation

A
  • drug interactions = any other CNS depressant, erythromycin, antihistamines
  • tolerance
  • dependanc
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7
Q

what were the preparations of diazepam used

A
  • had to be prepared as insoluble in water
  • organic solvents (valium) = propylene glycol
  • emulsified in soya bean oil (diazemulus)
  • pain on injection
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8
Q

what is the half-life of diazepam

A
  • 43 +/- 13 hours
  • redistribution 1/2 life = 40 mins
  • risk of rebound sedation
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9
Q

what dose of diazepam given

A
  • 0.1-0.2mg/kg
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10
Q

why is diazepam now superseded by midazolam

A
  • long recovery period
  • unpredictable
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11
Q

at what pH is midazolam water soluble

A
  • <4
  • lipid soluble at physiologic pH allowing crossing of the blood brain barrier
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12
Q

why is midazolam painless on injection

A
  • because it is water soluble
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13
Q

what dose of midazolam given

A
  • 5mg/ml
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14
Q

difference between midazolam and diazepam

A
  • more rapid onset and 2-3x more potent
  • elimination 1/2 life 90-150 mins
  • cheaper, safer and more reliable
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15
Q

where is midazolam metabolised

A
  • in liver
  • but also some exrta-heptaic metabolism in the bowel, so less affected by liver disease
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16
Q

why is a butterfly cannula not recommened

A
  • cheap and easy to use but made of metal so can clot easily
  • good for taking bloods
17
Q

what type of cannula should be used instead

A
  • one made of teflon
  • more secure and rarely blocks
  • has different colours for different sizes
18
Q

cannulation sites

A
  • dorsum of the hand = accessible, superficial and visible, poorly tethered and tend to move about while trying to cannulate them, affected by peripheral vasoconstriction
  • antecubital fossa = need to be aware of brachial artery and median nerve, less stable, second choice
19
Q

what topical aneasthesia is used

A
  • for skin
  • Ametop gel
  • not sued very often
20
Q

procedure for sedation

A
  • pre-op pulse and blood pressure measurement taken
  • high volume aspiration required
  • need to monitor continually throughout = pulse oximeter, NIBP measurements every 5-10 mins, allows intervention before emergency, minimises risk
  • 2mg bolus of drug given initially and monitor response then I’ve 1mg increments every 60 seconds until adequate sedation is achieved
  • get approx 30-45 mins of sedation
  • shouldn’t lose verbal communication throughout
  • pt must stay for 60 mins after last increment given
21
Q

what is the end point of administering drug

A
  • slurred speech
  • relaxed
  • delayed response to commands
  • willingness to accept treatment
  • Verill’s sign = ptosis (drooping of eyelid)
  • Eve’s sign = loss of motor coordination
22
Q

what to do if respiratory depression emergency

A
  • shake pt, head tilt jaw thrust to get more air in
  • give 2l O2/min via nasal cannula
  • if no improvement move to 5l/min with Hudson mask
  • if still nothing reverse with flumazenil
23
Q

features of flumazenil

A
  • 500mcg in 5ml
  • dose = 200mcg then 100mcg increments every 60 seconds until see a response
  • shorter 1/2 life than midazolam so risk of rebound sedation
  • brand name is Annexate

BDS4 sedation symposium (7 decks)

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