IV sedation Lecture #2

Question 1

What types of sedation are considered conscious sedation?

Answer 1

• Minimal

- Moderate

Question 2

Can the patient control their own airways under conscious sedation?

Answer 2

-Yes

Question 3

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

Answer 3

-Possibly but maybe not

Question 4

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

Answer 4

-Intubation of patient

Question 5

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

Answer 5

-Yes

Question 6

What is minimal sedation?

Answer 6

• Independent airway/respond normally

- Ventilation unaffected

Question 7

What is moderate sedation?

Answer 7

-Responds to verbal commands, respiratory and CVD unaffected

Question 8

What are some common Benzodiazepines used for IV sedation?

Answer 8

• Midazolam (versed)
• Diazepam (Valilum)
• Ativan

Question 9

What are opioids used for IV sedation?

Answer 9

• Morphine
• Fentanyl
• Demerol

Question 10

What are advantages of Oral sedation?

Answer 10

• Pt. acceptability
• Ease of administration
• Cost
• Variable amnesia
• Safe

Question 11

Where does oral sedation absorption occur?

Answer 11

-GI tract

Question 12

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

Answer 12

True

Question 13

What are the disadvantages of oral sedation?

Answer 13

• 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

Question 14

What are antihistamines/Barbiturates are used for oral sedation?

Answer 14

• Benadryl

- Hydralysine

Question 15

What effects do Benzodiazepines (not analgesic) have?

Answer 15

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

Question 16

What do Benzodiazepines target mostly?

Answer 16

-CNS GABA A receptors which are direct and fast acting

Question 17

T/F Benzodiazepine is analgesic

Answer 17

False

-Is not

Question 18

What is the onset of Diazepam (Valium)?

Answer 18

-60-90 minutes

Question 19

What is the half life of Valium?

Answer 19

-20-50 hours

Question 20

What dose of Valium do you give?

Answer 20

-5-15 mg 1 hour prior to appt

Question 21

Is Valium long acting?

Answer 21

-Yes

Question 22

What are the side effects of Valium?

Answer 22

• Drowsiness
• Ataxia
• Psychomotor impariment

Question 23

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

Answer 23

-No because it is an Category X drug

Question 24

What is another name for Triazolam?

Answer 24

-Halcion

Question 25

What is the onset of Triazolam (Halcion)?

Answer 25

-60-90 minutes

Question 26

What is the half life of Triazolam (Halcion)?

Answer 26

2.2 hours

Question 27

What dose do you give for Triazolam (halcion)?

Answer 27

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

Question 28

What are the side effects of Triazolam?

Answer 28

- Psychomotor impairment - Drowsiness - Light-headed - Confusion - Dream abnormalities - Hallucinations

Question 29

What is the other name for Midazolam?

Answer 29

-Versed

Question 30

What is the onset for Midazolam (Versed)?

Answer 30

-30-60 minutes up to 2 hours

Question 31

What is the half life of Midazolam (Versed)?

Answer 31

-1.5 - 2.5 hours

Question 32

What is the dose of Midazolam (versed)?

Answer 32

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

Question 33

What are the side effects of Versed (Midazolam)?

Answer 33

-Respiratory depression | potentiates the respiratory depression of phentenyl

Question 34

What is the other name for Flumazenil?

Answer 34

-Romazicon

Question 35

What is Flumazenil (Romazicon)?

Answer 35

-A reversal agent

Question 36

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

Answer 36

True

Question 37

What doses of Flumazenil (Romazicon) do you use?

Answer 37

-.2 mg to a maximum dose of 3 mg

Question 38

What is the onset of Flumazenil (Romazicon)?

Answer 38

-1-2 minutes

Question 39

What are the complication/contraindication of Benzodiazepine?

Answer 39

- Glaucoma - Respiratory depression - Birth defects (Cleft lip/Cleft Palate) - Valium

Question 40

Why is valium a contraindication of Benzodiazepine?

Answer 40

- Thrombophlebitis | - Extravasation into tissues

Question 41

Where is Diazepam metabolized?

Answer 41

-Liver

Question 42

T/F Clonazepam has a slower onset of action.

Answer 42

True

Question 43

What is Clonazepam used for?

Answer 43

-Adjunct for anxiolytic and sedative peoperties

Question 44

Is Diazepam soluble in water?

Answer 44

-No

Question 45

What sedative drug is more potent than Diazepam or Clonazepam?

Answer 45

-Midazolam (Versed)

Question 46

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

Answer 46

-Depress

Question 47

Is Midazolam solube in water?

Answer 47

-Yes

Question 48

What are the advantages of Nitrous oxide?

Answer 48

- 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

Question 49

What are the disadvantages of Nitrous oxide?

Answer 49

- Decreased efficacy for severely anxious pt - Unpredictable amnesia - Nausea, dizziness - Sexual hallucinations - Chronic exposure to staff

Question 50

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

Answer 50

True

Question 51

What are the contraindications of Nitrous oxide?

Answer 51

- Pregnancy - Sever blockage of nasal passages - Head injury - Pneumothoraces - Respiratory disease - Sever blocked Eustachian tube

Question 52

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

Answer 52

-Plane 1

Question 53

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

Answer 53

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Question 54

What are the predominant effect of opioids?

Answer 54

- Analgesia | - Depression of sensorium and respirations

Question 55

What are opioids used for oral sedation?

Answer 55

- Morphine - Meperidine - Fentanyl

Question 56

What do opioids do to the vasculature?

Answer 56

-Vasodilation leading to hypotension and increased CO

Question 57

What side effects do opioids have?

Answer 57

- Nausea - Chest wall rigidity - Seizures - Constipation - Urinary retention

Question 58

What does of Fentanyl do you give?

Answer 58

-30 to 50 micrograms 10-15 minutes by IV

Question 59

T/F Fentanyl and Versed potentiate respiratory depression.

Answer 59

True

Question 60

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

Answer 60

-Fentanyl then Versed

Question 61

What do opioids have to do with histamine?

Answer 61

-Can cause histamine release that could lead to anaphylactic shock

Question 62

What is Naloxone (Narcan)?

Answer 62

- Opioid reversal | - A pure antagonist that reverses analgesia and respiratory depression

Question 63

What is the duration of Naloxone?

Answer 63

-1 hour

Question 64

What dose do you give of Naloxone?

Answer 64

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

Question 65

What is Propofol?

Answer 65

-Hypnotic agents

Question 66

What type of analgesic properties does Propofol have?

Answer 66

-None

Question 67

What do you use Propofol for in anesthesia?

Answer 67

-Deep/general anesthesia

Question 68

What dose of Propofol do you use?

Answer 68

-.5 mg - 1 mg/kg dosing

Question 69

Who is propofol contraindicated for?

Answer 69

- Pediatric | - Pts allergic to egg and soy

Question 70

Does Ketamine have analgesic action?

Answer 70

-Yes