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Anesthesia II 2020 > IV sedation Lecture #2 > Flashcards

IV sedation Lecture #2 Flashcards

1
Q

What types of sedation are considered conscious sedation?

A
  • Minimal

- Moderate

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2
Q

Can the patient control their own airways under conscious sedation?

A

-Yes

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3
Q

If a person is in deep sedation can they control their own airways?

A

-Possibly but maybe not

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4
Q

If a person is in general anesthesia what do you need to do for the respiratory system?

A

-Intubation of patient

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5
Q

Does oral sedation have the ability to go beyond minimal or moderate sedation to deep or general?

A

-Yes

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6
Q

What is minimal sedation?

A
  • Independent airway/respond normally

- Ventilation unaffected

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7
Q

What is moderate sedation?

A

-Responds to verbal commands, respiratory and CVD unaffected

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8
Q

What are some common Benzodiazepines used for IV sedation?

A
  • Midazolam (versed)
  • Diazepam (Valilum)
  • Ativan
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9
Q

What are opioids used for IV sedation?

A
  • Morphine
  • Fentanyl
  • Demerol
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10
Q

What are advantages of Oral sedation?

A
  • Pt. acceptability
  • Ease of administration
  • Cost
  • Variable amnesia
  • Safe
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11
Q

Where does oral sedation absorption occur?

A

-GI tract

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12
Q

T/F No specialized training is required beyond the doctoral level for oral sedation

A

True

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13
Q

What are the disadvantages of oral sedation?

A
  • 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
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14
Q

What are antihistamines/Barbiturates are used for oral sedation?

A
  • Benadryl

- Hydralysine

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15
Q

What effects do Benzodiazepines (not analgesic) have?

A
  • Anti-anxiety
  • Sedative-hypnotic
  • Anti-convulsant
  • Skeletal muscle relaxant
  • Amnesic effect
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16
Q

What do Benzodiazepines target mostly?

A

-CNS GABA A receptors which are direct and fast acting

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17
Q

T/F Benzodiazepine is analgesic

A

False

-Is not

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18
Q

What is the onset of Diazepam (Valium)?

A

-60-90 minutes

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19
Q

What is the half life of Valium?

A

-20-50 hours

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20
Q

What dose of Valium do you give?

A

-5-15 mg 1 hour prior to appt

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21
Q

Is Valium long acting?

A

-Yes

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22
Q

What are the side effects of Valium?

A
  • Drowsiness
  • Ataxia
  • Psychomotor impariment
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23
Q

Do you ever want to give Triazolam to a pregnant patient?

A

-No because it is an Category X drug

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24
Q

What is another name for Triazolam?

A

-Halcion

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25
Q

What is the onset of Triazolam (Halcion)?

A

-60-90 minutes

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26
Q

What is the half life of Triazolam (Halcion)?

A

2.2 hours

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27
Q

What dose do you give for Triazolam (halcion)?

A

-.25 mg the night before and .25 to .5 mg 1 hr prior to appt.

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28
Q

What are the side effects of Triazolam?

A
  • Psychomotor impairment
  • Drowsiness
  • Light-headed
  • Confusion
  • Dream abnormalities
  • Hallucinations
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29
Q

What is the other name for Midazolam?

A

-Versed

30
Q

What is the onset for Midazolam (Versed)?

A

-30-60 minutes up to 2 hours

31
Q

What is the half life of Midazolam (Versed)?

A

-1.5 - 2.5 hours

32
Q

What is the dose of Midazolam (versed)?

A

-1-2 mg titration (usually given IV but some liquid versed is being used)

33
Q

What are the side effects of Versed (Midazolam)?

A

-Respiratory depression

potentiates the respiratory depression of phentenyl

34
Q

What is the other name for Flumazenil?

A

-Romazicon

35
Q

What is Flumazenil (Romazicon)?

A

-A reversal agent

36
Q

T/F The half life of the reversal agent is shorter than the half life of the drug you have given

A

True

37
Q

What doses of Flumazenil (Romazicon) do you use?

A

-.2 mg to a maximum dose of 3 mg

38
Q

What is the onset of Flumazenil (Romazicon)?

A

-1-2 minutes

39
Q

What are the complication/contraindication of Benzodiazepine?

A
  • Glaucoma
  • Respiratory depression
  • Birth defects (Cleft lip/Cleft Palate)
  • Valium
40
Q

Why is valium a contraindication of Benzodiazepine?

A
  • Thrombophlebitis

- Extravasation into tissues

41
Q

Where is Diazepam metabolized?

A

-Liver

42
Q

T/F Clonazepam has a slower onset of action.

A

True

43
Q

What is Clonazepam used for?

A

-Adjunct for anxiolytic and sedative peoperties

44
Q

Is Diazepam soluble in water?

A

-No

45
Q

What sedative drug is more potent than Diazepam or Clonazepam?

A

-Midazolam (Versed)

46
Q

What might Midazolam (Versed) do to respirations when used with narcotics?

A

-Depress

47
Q

Is Midazolam solube in water?

A

-Yes

48
Q

What are the advantages of Nitrous oxide?

A
  • 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
49
Q

What are the disadvantages of Nitrous oxide?

A
  • Decreased efficacy for severely anxious pt
  • Unpredictable amnesia
  • Nausea, dizziness
  • Sexual hallucinations
  • Chronic exposure to staff
50
Q

T/F In all oral sedation the pt needs an escort,

A

True

51
Q

What are the contraindications of Nitrous oxide?

A
  • Pregnancy
  • Sever blockage of nasal passages
  • Head injury
  • Pneumothoraces
  • Respiratory disease
  • Sever blocked Eustachian tube
52
Q

What is the deepest plane of anesthesia that you should allow nitrous to go to?

A

-Plane 1

53
Q

30-40% of nitrous oxide is analgesic and is compared to what amount of what other drug?

A

asdfasdfasdfasdfasdfasdf

54
Q

What are the predominant effect of opioids?

A
  • Analgesia

- Depression of sensorium and respirations

55
Q

What are opioids used for oral sedation?

A
  • Morphine
  • Meperidine
  • Fentanyl
56
Q

What do opioids do to the vasculature?

A

-Vasodilation leading to hypotension and increased CO

57
Q

What side effects do opioids have?

A
  • Nausea
  • Chest wall rigidity
  • Seizures
  • Constipation
  • Urinary retention
58
Q

What does of Fentanyl do you give?

A

-30 to 50 micrograms 10-15 minutes by IV

59
Q

T/F Fentanyl and Versed potentiate respiratory depression.

A

True

60
Q

When are using Fentanyl and Versed together which do you administer first?

A

-Fentanyl then Versed

61
Q

What do opioids have to do with histamine?

A

-Can cause histamine release that could lead to anaphylactic shock

62
Q

What is Naloxone (Narcan)?

A
  • Opioid reversal

- A pure antagonist that reverses analgesia and respiratory depression

63
Q

What is the duration of Naloxone?

A

-1 hour

64
Q

What dose do you give of Naloxone?

A

-.1-.2 mg with a max of 10 mg

65
Q

What is Propofol?

A

-Hypnotic agents

66
Q

What type of analgesic properties does Propofol have?

A

-None

67
Q

What do you use Propofol for in anesthesia?

A

-Deep/general anesthesia

68
Q

What dose of Propofol do you use?

A

-.5 mg - 1 mg/kg dosing

69
Q

Who is propofol contraindicated for?

A
  • Pediatric

- Pts allergic to egg and soy

70
Q

Does Ketamine have analgesic action?

A

-Yes

Anesthesia II 2020 (4 decks)

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