Moderate sedation Flashcards
What is the overarching goal of sedation/ analgesia?
minimize physical pain, discomfort and negative psychological responses by providing sedation, amnesia and analgesia, as needed, during painful, uncomfortable or prolonged procedures AND ensure rapid safe return to highest possible health status following the procedure.
minimal sedation (anxiolysis)
- responsiveness
- airway
- spontaneous ventilation
- cardiovascular function
- normal response to verbal simulation
- cognitive function and coordination may be impaired
- ventilatory and cardiovascular functions are unaffected
moderate sedation/ analgesia (conscious sedation)
- responsiveness
- airway
- spontaneous ventilation
- cardiovascular function
- purposeful response to verbal or tactile stimulation
- No interventions are required to maintain a patent airway and spontaneous ventilation is adequate.
- Cardiovascular function is usually maintained.
deep sedation/ analgesia
- responsiveness
- airway
- spontaneous ventilation
- cardiovascular function
- Drug-induced depression of consciousness, during which patients cannot be easily aroused but respond purposefully following repeated or painful stimu
- The ability to maintain independent ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate.
- Cardiovascular function is usually maintained.
general anaesthesia
- responsiveness
- airway
- spontaneous ventilation
- cardiovascular function
- Drug-induced loss of consciousness during which patients are not arousable, even by painful stimulations
- The ability to independently maintain ventilatory function is often impaired.
- Patients often require assistance in maintaining a patent airway and may require positive pressure ventilation because of depressed spontaneous ventilation or drug induced depression of neuromuscular function.
- Cardiovascular function may be impaired
what are the main objectives of procedural sedation
- Alteration of level of consciousness/mood
- Maintenance of consciousness
- Cooperation
- Elevation of the pain threshold
- Minimal variation of vital signs
- Rapid onset of amnesia
- Safe return to baseline
what are the undesirable effects of sedation and analgesia?
- Deep unarousable sleep
- Hypotension
- Bradycardia
- Agitation and combativeness
- Hypoventilation, respiratory depression
- Airway obstruction
- Apnoea
What aspects of the patient’s medical history is important before moderate sedation administration?
(1) Review of co-morbidities which may increase the risk for complications during the administration of MS, for example obesity, obstructive sleep apnoea, craniofacial abnormalities, cervical spine instability and organ dysfunction such as liver or kidney impairments
(2) Notation of any problems encountered with previous experiences with sedation/analgesia, as well as regional and general anaesthesia
(3) Current medications list
(4) Any drug allergies with their reactions
(5) Time and nature of the last oral intake
(6) History of alcohol, tobacco or substance abuse
What are the basic mandatory monitoring modalities during moderate sedation?
- BP every 5 min and the HR, ECG rhythm and SpO2 continuously
- level of consciousness (sedation score) and pain score should also be monitored and the expired PCO2 whenever possible.
- parameters must be charted at 5 min intervals onto the prescribed charts for procedural sedation.
what should be supplied to the patient during moderate sedation?
To avoid hypoxaemia, supplemental oxygen should be routinely provided during sedation via nasal cannulae or facemasks.
What drugs can only be used by anaesthesiologists?
propofol*, ketamine
how should sedative- analgesic medications should be given to the patient?
- Due to inter-individual variation in demand and response to sedatives and analgesic agents, it is safer to administer sedative-analgesic medications in small, incremental doses that are titrated to desired end-points, rather than giving a single dose based on patient size, weight or age.
- Incremental drug administration improves patient comfort and minimizes the risks for adverse effects.
- Sufficient time must also be allowed between doses for drugs to act before administering incremental doses.
What is the antagonist of benzodiazepines?
Flumazenil
what is the antagonist of opioids?
Naloxone
What must patient must have to be discharged after sedation?
• Ability to swallow or gag reflex
• Ability to ambulate with assistance or be at pre-procedural norm
• Limited nausea and/or vomiting
• Minimal or no pain resulting from the procedure
• No or resolved surgical or procedure-related complications
- Vital signs and respiratory function are monitored every 5 min until the vital signs and pulse oximetry are consistent with the range of pre-procedural norms and the sedation score is no more than 2 on the Ramsey scale or less than 8 on the Aldrete scale.
