Pain and Sedation

Question 1

What is RASS?

Answer 1

• Richmond Agitation and Sedation Scale

- Scored from +4 to -5

Question 2

What is CAM ICU?

Answer 2

Confusion Assessment Method for the ICU

• assess whether the pt has delirium
• is a flow chart style assessment

Question 3

Discuss Propofol, its indication and concentration and administration amount.

Answer 3

• Propofol is a short acting anaesthetic
• used for the induction , maintenance of anesthesia and sedation in mechanically ventilated pt.
• comes in a 1000mg/100mls
• starting rate is 2mg/hr/kg, to target RASS, usual rate is 5-20ml/hr

Question 4

Discuss Midazolam, its concentration and administration rate.

Answer 4

• Midazolam is a short acting muscle relaxant
• it is a CNS depressant inducing sedation, hypnosis, amnesia and anaesthesia
• used for agitation, sedation, intubation and short procedures
• comes in a concentration of 50mg/10mls and made to infusion with N/S of 50mg/50mls
• initial rate 2mg/hr
• usual rate of 0-10mg/hr

Question 5

what is the reversal agent for Midazolam?

Answer 5

-Flumazenil

Question 6

What is Fentanyl, its indications, concentration and administration for this drug?

Answer 6

• Fentanyl is a synthetic opioid analgesia
• used for pain management for moderate to severe pain
• comes in a concentration of 500mcg/10ml
• made up into 500mcg/50ml of N/S
• titrated to CPOT, usual starting rate 2ml/hr

Question 7

What is the adverse reactions of Fentanyl?

Answer 7

• respiratory depression
• hypotension
• Prolonged QT interval
• diaphoresis

Question 8

what is the reversal agent for Fentanyl?

Answer 8

• Naloxone

- 500mcg/50mls

Question 9

Discuss Ketamine, its indication, concentration and administration rate.

Answer 9

• Ketamine is a general anaesthetic, bronchodilator, can improve pulmonary compliance
• can be used as general anaesthesic analgesia and bronchodilator
• comes in the concentration of 200mg/200ml
• initial rate 0.04-0.1mg/kg/hr
• usual range: 0.1-0.2mg/kg/hr

Question 10

Discuss Dexmedetomidine, its indication, concentration and administration rate.

Answer 10

-Dexmedetomidine is a alpha2 adrenoreceptor agonist
- it decreased CNS actiivty, can decrease HR and BP
- used for when trying to desedate pt
used for agitation and tube tolerance
-comes in a concentration of 400mcg/100mls
-initial dose 0.2mcg/kg/hr (3-5ml/hr)
- usual rate of up to 1mcg/kg/hr (6-10mls/hr)