IV sedation Flashcards
Indications for IV sedation..
Psychological
Difficult tx
MH
Gag reflex
To avoid GA
Contraindications for IV sedation..
Allergy
Children
Extensive tx
Needle phobia
No escort
IV drug user
Pregnancy
Liver or renal disease
Obese BMI over 35
Iv sedation advantages…
Rapid onset
Controllable - titrated
Anxiolytic
Amnesic
IV access - for emergency drugs
Iv sedation disadvantages…
Gaining IV access
Time consuming
Needle phobic
What are the 4 intravenous agents?
Diazepam
Midzolam
Propofol
Fentanyl
How can diazepam be given?
Orally, IM or IV
What is the half life of diazepam?
43 hours
How long can recovery take with diazepam?
72 hours
What family does Midazolam belong to?
Benzodiazepine
Midazolam has a…
Rapid onset
What is the short half life of midazolam?
1.9hrs
What does midzolam do?
Muscle relaxant, anticonvulsant, amnesia, analgesia
How long does it take for midazolam to travel from the arm to the brain?
35 seconds
How is midazolam redistributed?
Muscle and fatty tissue
How is midazolam eliminated?
liver and excreted by kidney
What is Flumazenil?
Midazolam reversal
What is the brand name of flumazenil?
Anexate
What is the half life of Flumazenil?
50 mins
What airway assessment will be completed for IV sedation?
Mallampati classification
What is a common benzodiazepine pre-medication?
Temazepam 5mg
x2 tabls one night before and one 1hr before app
Escort required
Pre op instructions for IV sedation?
No food/drink 2 hrs before - light meal
Escort
Appropriate travel
No alcohol 24hrs before
Medication take as normal
Bring inhalers / GTN spray
Nail varnish removed
Post op instructions for IV sedation?
No alcohol for 24 hrs
No driving/ operating machinery
Not to be left alone
No important decisions
Avoid social media
What would happen if the treatment changed during IV sedation?
Treatment cannot be consented to, so pt will have to be brought back to discuss options
What size is the green IV cannula?
18G
What size is the pink IV cannula?
20G
What size is the blue IV cannula?
22G
What size is the yellow IV cannula?
24G
Which is the flow rate of the yellow IV cannula?
20 ml/min
Which is the flow rate of the blue IV cannula?
33ml/min
How should Iv drugs be administered?
Titrated
what does bolus mean?
Rapid administration
How should IV midazolam be administered ?
1mg bolus over 30sec
wait 1 min
Common areas for cannulation?
Dorsum - hand
Antecubital fossa - infront of elbow
Benzodiazepines are
Sedation, muscle relaxants, and anterograde amnesia
What other name is midazolam known by?
Hypnovel
What year was midazolam available in the UK?
1983
what schedule of controlled drug is midazolam classified as?
schedule III controlled drug
midazolam is available in what presentations
10mg in 5ml
10mg in 2ml
5mg in 5ml
What does the blue dot on the ampoule represent?
Signifies the place to hold to get ease for opening
What is the PH of midazolam?
3.4
If a patient had an allergic reaction to midazolam, how would the reaction be managed
adrenaline IV - 0.5ML 1:10000
IM - O.5ML 1:1000
What does Anxiolytic mean?
Reduces anxiety
Midazolam binds to which receptors in the CNS?
Benzodiazepine receptors
Benzodiazepine receptors run parallel to which other receptors?
Gamma-aminobutyric acid (GABA)
Benzodiazepine enhances the effect of neurotransmitters on the GABA receptors leading the brain to do what?
Decreased brain activity
What is half-life?
The time it takes for plasma levels of the drug to drop in half
Name the two stages that form the Benzodiazepines half-life?
Alpha & Beta
What does the Alpha half-life do?
Distribution and redistribution - travels to the brain and then from the brain to other tissues in the body.
How long is the Alpha half-life?
4-18 minutes
What does the Beta half-life do?
Metabolism & Excretion (the body breaks down so it is no longer active, then removed from the body)
How long is the Beta half-life?
1-4 hours (can be longer for elderly/teens)
