Introduction to IV sedation Flashcards
what would be the ideal aspects of an IV sedation agent?
- anxiolysis
- sedation
- ease of administration
- non-irritant
- quick onset
- quick recovery
- no side effects
- low cost
what is the action of benzodiazepines?
Acts on receptors in CNS to enhance effect of GABA
- prolongs time for receptor repolarisation
- mimics effects of glycine on receptors
What structural area of BZDs allow them to attach to receptors in the CNS?
The benzene ring
What are the effects of sedative agents on the respiratory organs?
Respiratory depression
- CNS depression & muscle relaxation
- decreases cerebral response to increased CO2
What are the effects of sedative agents on the cardiovascular system?
- decreased BP by muscle relaxation decreasing vascular resistance
- increased HR due to baroreceptor reflex compensating for BP fall
What are some specific drugs that interact with sedative agents?
- antihistamines
- erythromycin
- any other CNS depressants
what is the gold standard IV sedative drug used in dentistry?
Midazolam
What is the dose of one preparation of Midazolam?
5mg/5ml (pH 3.5)
what is the elimination half life of midazolam?
90 - 150 mins
where is midazolam metabolised?
liver
How does Midazolam compare to Diazepam?
Midazolam is:
- painless on injection
- quicker onset
- quicker recovery
- more reliable
Who are the members of the sedation team?
- operator sedationist
- second sedation trainer person (e.g trained dental nurse)
- must also have someone else in practice for reception & as runner
- patients escort present at all times
What type of cannula is used?
In-dwelling cannula
How might you make it easier to cannulate a patients hand?
Warm up their hand and tourniquet
What monitoring measurements are taken during a sedation procedure?
- NIBP every 5-10 mins
non invasive blood pressure
What drug can be used to reverse Midazolam?
Flumazenil
When midazolam is administered, what are the values/increments?
- Initial 2mg bolus
- Watch for 1 minute to see how patient responds
- Then 1mg increments every 60 seconds until desired sedation (10mg max)
What are some signs of the end point of sedation?
- slurring & slowing of speech
- delayed responses to demands
- willingness to accept treatment
- Verril’s sign-ptosis
- Eve’s sign (loss of motor coordination)
what is Verril’s sign?
drooping eyelids
What is crucial to ensure during sedation?
DO NOT LOSE VERBAL COMMUNICATION OR CONSCIOUSNESS
What are the aspects of recovery post sedation?
- keep patient until 60 mins after last increment
- cannula needs to be removed
- ensure patient can walk unaided
- escort given post op instructions
what steps do you follow if patient experiences respiratory depression?
- talk, shake
- head tilt, chin lift, jaw thrust
- encourage deep breaths
- give supplemental oxygen (2ml/min nasal cannulae)
- if no improve 5l/min via Hudson mask
- Flumazenil if still no improvement
- Ambu bag
- Airways
What is the preparation of Flumazenil used in practise?
500 micrograms in 5 ml
What is the dose of Flumazenil given to reverse sedation in practise?
- 200 micrograms initially
- 100 micrograms increments every 60 secs until response seen
What is Flumazenils trade name?
Anexate
