Moderate & Deep Sedation Flashcards
What drugs are used for minimal sedation (anxiolysis)?
- Morphine
- Dilaudid
What is moderate sedation & what drugs are used for this type of sedation?
KNOW THIS!!!!!
Drug induced depression of consciousness but the patients respond purposefully to verbal commands
- patient should be able to mantain their airway
Ketamine & Propofol
What key thing should patients under moderate sedation (analgesia) be able to do?
Maintain their airway
In what instances is moderate sedation often used?
- Drainage in sensitive areas (rectal abscess)
- Shoulder or hip dislocation
Explain each of the ASA (American Society of Anesthesiologists) Classifications
- ASA I: normal healthy patient, no organic, pathological, biochemical, or psychiatric disturbance or disease
- ASA II: Patient with mild to moderate systemic disturbance or disease
- ASA III: Patient wiht severe systemic disturbance or disease
- ASA IV: Patient with severe & life-threatening systemic disease or disorder
- ASA V: Patient who is unlikely to survive without the planned procedure
What is an ASA I classification?
KNOW THIS!!!
Normal healthy patient with no organic, pahtologic, biochemical, or psychiatric disturbance or disease
What is ASA II Classification?
KNOW THIS!!!!
Patient with mild to moderate systemic disturbance or disease caused by either the condition to be treated or another pathological process
- slightly limited heart disease
- well-controlled HTN
- anemia
- smoker w/out significant respiratory disease
- pregnancy
- well-controled diabetes
- neoplastic disease with chemotherapy
What is ASA III Classification?
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Patient with severe systemic disturbance or disease
- Angina
- Poorly controlled HTN
- Past MI w/ current mild to moderate symptoms
- systemic respiratory disease (COPD, Asthma, etc.)
What is ASA IV Classification?
KNOW THIS!!!
Patient with severe & life-threatening systemic disease or disorder
- unstable angina
- active or chronic CHF
- hepatorenal failure (requires dialysis)
- patient in SVT who is cardioverted
What is ASA V Classification?
KNOW THIS!!!
Patient who is unlikely to survive without the planned procedure
- rutured aneurysm with severe shock
- massive PE
- major cerebral trauma w/ rapidly increasing ICP
What is Mallampati Scoring?
KNOW THIS!!! - BOLD, RED
Allows providers to know how difficult intubation will be on a patient
I: full visualization (soft palate, hard palate, & uvula visible)
II: only soft palate & uvula are visible
III: soft palate & part of the uvula are visible
IV: hard to visualize (only soft palate is visible)
What drugs are used for moderate / deep sedation?
KNOW THIS!!! - BOLD, RED
Propofol & Ketamine
- must be pushed by the provider
Safety to remember when sedating patients
IMPORTANT!
- all sedatives & narcotics can cause respiratory depression
- Sedatives & analgesics have a cumulative effect
What are the two goals when sedating a patient regarding medication that is given?
Sedate the patient & pain relief
- sedative + opioid (for pain)
Sedatives:
* Propofol
* Benzodiazepines (Versed, Valium, Ativan)
+
Opioids
* Dilaudid
* Morphine
* Fentanyl
Rescue Capacity Care During Sedation
KNOW THIS!!! - RED, BOLD
- IV access & fluids running
- Ensure access to rescue equipment including crash cart
- Bag-Valve Mask
- Suction
- Intubation equipment
- Reversal agents
Monitoring During Care of Sedated Patients
KNOW THIS!!! - RED, BOLD
- 1:1 (nurse cannot multitask)
- Continuous Pulse Ox
- BP & vitals every 5 minutes (during procedure)
- Continuous EKG monitoring
How often are vitals measured during and after a procedure with mdoerate/deep sedation? At what point can that monitoring stop and what does monitoring interval go to?
- During: LOC, BP, & respiratory status every 5 minutes
- After Procedure: every 15 minutes until the patient gets to the point where they were at in terms of LOC & vitals pre-procedure
What are the antedotes / reversal agents for opioids & benzodiazepines?
KNOW THIS!!! – IN RED, BOLD, HIGHLIGHTED!!!!!
Opiods = naloxone (Narcan)
Benzodiazepines = flumazenil (Romazicon)
What is the antedote for opioids?
KNOW THIS!!!! - RED, BOLD
naloxone (Narcan)
What is the antedote for benzodiazepiens?
KNOW THIS!!!! - RED, BOLD
flumazenil (Romazicon)
What immediate interventions can be used for a patient in moderate / deep sedation who goes into respiratory distress?
KNOW THIS!!!! - RED, BOLD
- Stop sedation
- Check LOC
- Chin Lift (maintain airway)
- Assist ventalations with bag-valve mask
- Reversal agents
- Call anesthesia
What does aldrete score measure?
- LOC
- BP
- O2 sat
- Activity
- Respirations
- Nausea
Highest is a 15
What is a sedation awakening trial?
Patient is taken off all sedation medications to assess their neuro status & if they understand what’s going on. Occurs at least once per day:
* turn off sedative infusions & stop analgesics
* Assess Richmond Agitation Sedation Scale (RASS) or the Riker Sedation-Agitation Scale (SAS)
* Assess LOC & neuro function
True or False? Sedation negates the need for analgesia in mechanically intubated patients.
FALSE
