IV sedation Lecture #2 Flashcards
What types of sedation are considered conscious sedation?
- Minimal
- Moderate
Can the patient control their own airways under conscious sedation?
-Yes
If a person is in deep sedation can they control their own airways?
-Possibly but maybe not
If a person is in general anesthesia what do you need to do for the respiratory system?
-Intubation of patient
Does oral sedation have the ability to go beyond minimal or moderate sedation to deep or general?
-Yes
What is minimal sedation?
- Independent airway/respond normally
- Ventilation unaffected
What is moderate sedation?
-Responds to verbal commands, respiratory and CVD unaffected
What are some common Benzodiazepines used for IV sedation?
- Midazolam (versed)
- Diazepam (Valilum)
- Ativan
What are opioids used for IV sedation?
- Morphine
- Fentanyl
- Demerol
What are advantages of Oral sedation?
- Pt. acceptability
- Ease of administration
- Cost
- Variable amnesia
- Safe
Where does oral sedation absorption occur?
-GI tract
T/F No specialized training is required beyond the doctoral level for oral sedation
True
What are the disadvantages of oral sedation?
- Slow onset of action
- Pt compliance
- Low efficacy
- Titration of dose unclear
- Prolonged duration of effect
- Difficulty of administering reversal agents
- Meals and drug interaction
What are antihistamines/Barbiturates are used for oral sedation?
- Benadryl
- Hydralysine
What effects do Benzodiazepines (not analgesic) have?
- Anti-anxiety
- Sedative-hypnotic
- Anti-convulsant
- Skeletal muscle relaxant
- Amnesic effect
What do Benzodiazepines target mostly?
-CNS GABA A receptors which are direct and fast acting
T/F Benzodiazepine is analgesic
False
-Is not
What is the onset of Diazepam (Valium)?
-60-90 minutes
What is the half life of Valium?
-20-50 hours
What dose of Valium do you give?
-5-15 mg 1 hour prior to appt
Is Valium long acting?
-Yes
What are the side effects of Valium?
- Drowsiness
- Ataxia
- Psychomotor impariment
Do you ever want to give Triazolam to a pregnant patient?
-No because it is an Category X drug
What is another name for Triazolam?
-Halcion
What is the onset of Triazolam (Halcion)?
-60-90 minutes
What is the half life of Triazolam (Halcion)?
2.2 hours
What dose do you give for Triazolam (halcion)?
-.25 mg the night before and .25 to .5 mg 1 hr prior to appt.
What are the side effects of Triazolam?
- Psychomotor impairment
- Drowsiness
- Light-headed
- Confusion
- Dream abnormalities
- Hallucinations
What is the other name for Midazolam?
-Versed
What is the onset for Midazolam (Versed)?
-30-60 minutes up to 2 hours
What is the half life of Midazolam (Versed)?
-1.5 - 2.5 hours
What is the dose of Midazolam (versed)?
-1-2 mg titration (usually given IV but some liquid versed is being used)
What are the side effects of Versed (Midazolam)?
-Respiratory depression
potentiates the respiratory depression of phentenyl
What is the other name for Flumazenil?
-Romazicon
What is Flumazenil (Romazicon)?
-A reversal agent
T/F The half life of the reversal agent is shorter than the half life of the drug you have given
True
What doses of Flumazenil (Romazicon) do you use?
-.2 mg to a maximum dose of 3 mg
What is the onset of Flumazenil (Romazicon)?
-1-2 minutes
What are the complication/contraindication of Benzodiazepine?
- Glaucoma
- Respiratory depression
- Birth defects (Cleft lip/Cleft Palate)
- Valium
Why is valium a contraindication of Benzodiazepine?
- Thrombophlebitis
- Extravasation into tissues
Where is Diazepam metabolized?
-Liver
T/F Clonazepam has a slower onset of action.
True
What is Clonazepam used for?
-Adjunct for anxiolytic and sedative peoperties
Is Diazepam soluble in water?
-No
What sedative drug is more potent than Diazepam or Clonazepam?
-Midazolam (Versed)
What might Midazolam (Versed) do to respirations when used with narcotics?
-Depress
Is Midazolam solube in water?
-Yes
What are the advantages of Nitrous oxide?
- ease of use
- Rapid onset of action
- Ability to titrate effect
- Analgesic and sedative properties
- Few drug-drug interactions
- Rapid recovery
- No escort/restriction of activities
What are the disadvantages of Nitrous oxide?
- Decreased efficacy for severely anxious pt
- Unpredictable amnesia
- Nausea, dizziness
- Sexual hallucinations
- Chronic exposure to staff
T/F In all oral sedation the pt needs an escort,
True
What are the contraindications of Nitrous oxide?
- Pregnancy
- Sever blockage of nasal passages
- Head injury
- Pneumothoraces
- Respiratory disease
- Sever blocked Eustachian tube
What is the deepest plane of anesthesia that you should allow nitrous to go to?
-Plane 1
30-40% of nitrous oxide is analgesic and is compared to what amount of what other drug?
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What are the predominant effect of opioids?
- Analgesia
- Depression of sensorium and respirations
What are opioids used for oral sedation?
- Morphine
- Meperidine
- Fentanyl
What do opioids do to the vasculature?
-Vasodilation leading to hypotension and increased CO
What side effects do opioids have?
- Nausea
- Chest wall rigidity
- Seizures
- Constipation
- Urinary retention
What does of Fentanyl do you give?
-30 to 50 micrograms 10-15 minutes by IV
T/F Fentanyl and Versed potentiate respiratory depression.
True
When are using Fentanyl and Versed together which do you administer first?
-Fentanyl then Versed
What do opioids have to do with histamine?
-Can cause histamine release that could lead to anaphylactic shock
What is Naloxone (Narcan)?
- Opioid reversal
- A pure antagonist that reverses analgesia and respiratory depression
What is the duration of Naloxone?
-1 hour
What dose do you give of Naloxone?
-.1-.2 mg with a max of 10 mg
What is Propofol?
-Hypnotic agents
What type of analgesic properties does Propofol have?
-None
What do you use Propofol for in anesthesia?
-Deep/general anesthesia
What dose of Propofol do you use?
-.5 mg - 1 mg/kg dosing
Who is propofol contraindicated for?
- Pediatric
- Pts allergic to egg and soy
Does Ketamine have analgesic action?
-Yes
