IV Sedation Technique

Question 1

what qualities does the ideal sedation agent have

Answer 1

anxiolysis
sedation
ease of administration
non-irritant
quick onset
quick recovery
low cost
no side effects
amnesia

Question 2

what is the mechanism of action of benzodiazepines

Answer 2

enhance the effect of GABA and prolong time for receptor repolarisation
mimics effects of glycine on receptors

Question 3

what are the effects of BZDs

Answer 3

respiratory depression
cardiovascular effects

Question 4

what occurs with respiratory depression

Answer 4

CNS depression and muscle relaxation
decreased cerebral response to increased CO2

Question 5

what are the cardiovascular effects of BZDs

Answer 5

decreased BP by muscle relaxation decreasing vascular resistance
increased heart rate due to baroreceptor reflex compensating for BP fall

Question 6

what are the side effects of BZDs

Answer 6

drug interactions
tolerance
dependence
sexual fantasies

Question 7

what are the issues with using diazepam as a sedative

Answer 7

insoluble in water
propylene glycol is in it which causes pain
long elimination half life
long recovery and unpredictable

Question 8

what are the advantages of midazolam

Answer 8

soluble in water so is painless
short elimination half life
2-3x more potent than diazepam

Question 9

what is the concentration of midazolam used

Answer 9

5mg/ml

Question 10

what is the pH of midazolam

Answer 10

3.5

Question 11

where is midazolam metabolised

Answer 11

liver

Question 12

who is part of the sedation team

Answer 12

operator and sedation nurse

Question 13

what type of cannula is used

Answer 13

indwelling cannula

Question 14

what sites can be used for sedation

Answer 14

dorsum of hand
antecubital fossa

Question 15

what are the advantages of using the dorsum of the hand

Answer 15

accessible
superficial and visible veins

Question 16

what are the disadvantages of using the dorsum of the hand for sedation

Answer 16

poorly tethered
affected by peripheral vasoconstriction

Question 17

what anatomical structures can make using the antecubital fossa for sedation risky

Answer 17

brachial artery
median nerve

Question 18

what is the pre sedation procedure

Answer 18

take pre-op pulse and BP
get escort to stay in building
confirm home travel arrangements
reconfirm consent
have emergency drugs ready
have the monitor ready and set up

Question 19

what is the procedure for cannulating a patient

Answer 19

have pulse oximeter and BP monitored
administer drug

Question 20

how much midazolam is administered per minute

Answer 20

2mg bolus initially
wait for 60 seconds
then 1mg increments every 60 seconds

Question 21

what is the limit of midazolam you can give

Answer 21

7.5mg

Question 22

how do you know you are at the end point of sedating a patient

Answer 22

slurring and slowed speech
relaxed
willingness to accept treatment
delayed response to commands
eyes drooping
loss of motor coordination

Question 23

how much time do you get for a procedure with useful sedation

Answer 23

30-45mins

Question 24

what is the recovery procedure after sedation

Answer 24

keep 60mins after last increment given
escort should be with patient
remove cannula
give post op instructions
patient must be able to walk before they can leave

Question 25

what is the order of things you would do if respiratory depression occurs

Answer 25

shake patient and ask for a response head tilt, chin lift, jaw thrust O2 via nasal cannula (2l/min) hudson mask (5l/min) give flumazenil use ambu bag oropharyngeal airways

Question 26

what is the strength of flumazenil

Answer 26

500mcg in 5ml

Question 27

what is the dosage of flumazenil given

Answer 27

200mcg wait 60 seconds then 100mcg increments every 60s until response seen

Question 28

what is the risk of using flumazenil

Answer 28

re-sedation