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5th ICP - Pain/ Anxiety > IV Sedation III > Flashcards

IV Sedation III Flashcards

1
Q

What is midazolam?

A

Benzodiazpine

Clear, colourless and isotonic solution

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2
Q

pH of midazolam?

A

3.3 - acidic, not painful on infection

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3
Q

How do benzodiazepine work?

A

Enhance inhibitory action of GABA in CNS

Benzodiazepine potentiate GABA by increase Cl ion into cell - decreasing ability to initiate action potential

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4
Q

Where do benzodiazepine bind?

A

GABA A receptor

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5
Q

Diff of GABA A vs GABA B?

A

A - modulated by other recoptors

B = skeletal muscle role

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6
Q

Modulation GABA A?

A

Opening receptor channels = Cl influx

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7
Q

Effects of benzodiazepine

A

SAD AAH

Sedative
Anxiolytic
Decrease muscle tone
Anticonvulsant
Amnesia 
Hypnotic
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8
Q

How long should pt stay after sedation?

A

Min 1 hour last dose of sedative

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9
Q

Onset of action of midazolam?

A

IV = 3 minutes

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10
Q

What factors increase half life of midazolam?

A

Age - elderly
Sepsis
Poor renal function

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11
Q

Additional effects midazolam?

A

Decrease ventilatory response
Decrease mean arterial pressure
Reduction cerebral blood flow

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12
Q

Contraindication giving midazolam?

A

Allergy

Myasthenia gravis - due muscle relaxation can cause respiratory depression

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13
Q

Signs midazolam overdose?

A

Over sedation
Confusion
Diminished relfex
Decreasing vital sign

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14
Q

How to tx midazolam overdose?

A

Stop midazolam
Oxygen
Flumazenil

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15
Q

What dose of flumazenil should be given?

A

200-600ug IV

Competitive inhibitor of midazolam

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16
Q

Why is there a risk of re-sedation once given flumazenil?

A

Difference in half life - rare to happen

17
Q

How to titrate midazolam?

A

Slow titration of 2mg

Wait 90 sec and re-assess before giving 1mg more until desired sedation

18
Q

Requirement of pt preparation?

A 
Pre-assessment: baseline obvs
MH
ASA assessment
Written consent
Pre-op instructions
19
Q

What should do if get intra-arterial access?

A

If pre-drug remove cannula and apply pressure

Post-drug - leave cannula and contact local vascular surgeon

20
Q

What are issues w/ cannulation?

A

Transfixation
Haematoma
Embolism

21
Q

Monitoring required for IV sedation?

A

BP, HR and O2 sats

Vital signs

22
Q

Why is LA required during sedation?

A

Midazolam doesn’t give clinical analgesia

23
Q

What post-op should pt be aware of?

A 
For 24 hrs should follow
No driving/ operating machinery
No alcohol or sedative drugsd
Undertake no legal responsibility - work/ childcare
Shouldn't be left alone
Avoid social media
24
Q

How dispose unused midazolam?

A

Should be witnessed

25
Q

Occurrence of sexual fantasy w/ midazolam?

A

1 in 200 cases

5th ICP - Pain/ Anxiety (10 decks)

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