IV sedation Flashcards
What is the minimal number of available personnel that should be around when doing sedation?
-Three
the operator, the assistant, and the monitor
The doctor must be certified how when doing sedation?
-ACLS
What happens to the airway when doing minimal sedation?
-It is unaffected
In spontaneous ventilation what occurs in minimal sedation?
-It is unaffected
What occurs with cardiovascular function in minimal sedation?
-It is unaffected
What type of responsiveness is seen in minimal sedation?
-Normal response to verbal stimulation
What is the responsiveness in moderate sedation?
-Purposeful response to verbal or tactile stimulation
What happens to the airway in moderate sedation?
-No intervention required
What type of spontaneous ventilation do you get in moderate sedation?
-Adequate
What occurs with cardiovascular function in moderate sedation?
-Usually maintained
What occurs with cardiovascular function in deep sedation?
-Usually maintained
What occurs with cardiovascular function in general anesthesia?
-May be impaired
What type of spontaneous ventilation do you get in deep sedation?
-May be inadequate
What type of spontaneous ventilation do you get in general anesthesia?
-Frequently inadequate
In deep sedation what might you need to do with the airway?
-You may need intervention
In general anesthesia what might you need to do with the airway?
-Intervention is often required
What is the responsiveness of someone under deep sedation?
-Purposeful response following repeated or painful stimulation
What is the responsiveness of someone under general anesthesia?
-Unarousable even with painful stimulus
What may accentuate hemodynamic/respiratory depression caused by sedatives and analgesics?
-Cardiopulmonary disease
If a person has cardiopulmonary disease what might that require?
-decreased drug dosages and EKG monitoring
What increases airway irritability and risk of bronchospasm during sedation?
-Tobacco use
What classification system is used to asses airways?
-Mallampati
If a person is a Mallampati Class I what do you see?
- Soft palate
- Uvula
- Pillars visible
What can you see in a Mallampati Class II?
- Soft Palate
- Uvula
What can you see in a Mallampati Class III?
- Soft palate
- Base of uvula
What can you see in a mallampati Class IV?
-Soft palate not visible at all
What thyromental distance is a nonreassuring finding during airway PE?
-less than 3 ordinary finger breadths
How long should you not eat before being sedated?
- 8 hours if fried fatty foods/ meat
- 6 hours if a light meal
What things are required when monitoring the pt under sedation?
- Pulse oximeter
- Sphygmomanometer
- EKG
- Capnography
What is normal ETCO2?
35-45mmHg
What are medications used for sedation?
- Opioids
- Benzodiazepine
- Barbiturates
- Propofol
- Ketamine
- Reversal agents
What do opioids provide?
- Analgesia
- Sedation
Where can opioids acccumulate?
-Reservoirs of fate potentially producing long lasting effects
Morphine is how many times more potent than meperidine?
-10 x
Morphine is how many time less potent than hydromorphone?
-10 x
Morphine is how many times less potent than fentanyl?
-100x
What is the average dose of Fentanyl?
50-100 mcg
What is the duration of Fentanyl?
-.5 to 1 hour
What are the effects of benzodiazepines?
- Amnesia
- Anticonvulsant
- Anxiolytic
- Behavioral disinhibition
- Muscle relaxant
What might cause thrombophlebitis?
- Diazepam
- Lorazepam
What is likely to produce apnea?
-Midazolam
What drug carries an increased risk of progression to deep sedation?
-Propofol
What does propofol do?
- Sedation
- Amnesia
- NO analgesia
What is a dissociative anesthetic?
-Ketamine NMDA antagonist
What is ketamine a derivative of?
-Phencyclidine
T/F Ketamine is a potent pain reliever.
True
What might ketamine cause?
- Nystagmus
- Vocalizations
- Myoclonus
What is an opioid antagonist which binds to CNS opioid receptors to displace opioid agonists?
-Naloxone
What is a reversal agents that binds to GABA receptors in the CNS to reverse effects of benzodiasepines
-Flumazenil
What dose of flumazenil do you need to give to reverse benzodiazepines?
-.1 and .2 mg
What dose of Naloxone do you need to give to reverse opioids?
-.02 to .04 mg
What sedatives have no reversal agents?
- Propofol
- Ketamine
