IV sedation Flashcards
GDC definition of concious sedation
-A technique in which the the use of a drug or drugs
produces a state of depression of the central nervous
system enabling treatment to be carried out, but during
which communication can be maintained and the
modification of the patient’s state of mind is such that the patient will respond to command throughout the period of sedation. Techniques used should carry a margin of safety wide enough to render unintended loss of consciousness
unlikely.
Important aspects of sedation history
- complaint
- MH
- SH: anxiety/escort/responsibilities/transport
- DH
Name the ASA classifications
ASA I: healthy person
ASA II: mild systemic disease
ASA III: moderate systemic disease that limits activity
ASA IV: incapacitating systemic disease, threat to life
ASA V: moribund, not expected to live >24hr
Examples of conditions deeming a patient to be:
ASA II
- pregnancy
- well controlled epilepsy
- well controlled asthma
- NID diabetes (t2)
- hypertension: 140-159/90-94
Examples of conditions deeming a patient to be:
ASA III
- ID diabetes (t1)
- post MI >6/12 months
- post CVA >6/12 months
- COPD
- STABLE angina
- hypertension: 60-199/95-114
Examples of conditions deeming a patient to be:
ASA IV
- unstable angina
- < 6/12 post. MI
- < 6/12 post. CVA
- severe COPD
- hypertension > 200/115
Vital signs/information taken prior to sedation
- height + weight = BMI
- BP
- HR
medical cautions for sedation
Conditions aggravated by stress • IHD • Hypertension • Asthma • Epilepsy • Conditions affecting co-operation • Mental and physical handicap • Parkinson's
medical contraidications for sedation
Severe systemic disease • Severe special needs • COPD • Drugs • Pregnancy / Lactation • Severe psychiatric problems
Action of IV sedation agent: Benzodiazepines
-act on CNS receptors to enhance effect of GABA
prolongs time for receptor repolarisation
Effect of benzodiazepines on patients
- resp
- CVS
Respiratory system:
- CNS depression & muscle relaxation
- decreases cerebral response to CO2
CVS
- DECREASES BP, decreasing vascular resistance
- INCREASES HR due to baroreceptor reflex (compensate)
Midazolam:
- measurement - dose given
- pH
- half life
- where metabolised
- benefits of midazolam over diazepam?
- 5mg/5ml
- 2mg bolus then 1mg every minute
- pH 3.5
- half life: 90-150 mins
- metabolised in liver
- quicker onset/quicker recovery
If giving IV sedation into the antecubital fossa:
- what structures should you be aware of
- where should you place the needle
- median nerve
- brachial artery
-keep LATERAL
Reversal agent for Midazolam
Flumazenil 500mcg in 5ml
- 200mcg bolus then 100mcg every minute
- shorter half life
Examples of signs that patient is ready for treatment:
-2 named signs?
- slurring of speech
- relaxed
- delayed response to commands
- willingness to accept treatment
- Verrill’s sign: ptosis (closing of eyes)
- Eve’s sign: able to touch nose (negative if able/positive if not)
