Parenteral Sedation Flashcards
what are the stages of general anesthesia?
I. Analgesia (disorientation)
II. Delirium (excitatory, ultralight GA)
III. Surgical Anesthesia (planes = decr resp response)
Plane 1 (eyelid reflex is lost, beginning of resp response decrease)
Plane 2 (thoracic resp continues to decrease)
Plane 3 (intercostal paralysis; abdominal resp predominate)
Plane 4 (abdominal resp decreases until spontaneous breathing ceases)
IV. Medullary Paralysis
Begins with onset of resp arrest and ends with cardiac arrest
T/F you can’t just give an oral sedation for general anesthesia, you need to also give intramuscular sedation, inhilation sedation, and intravenous sedation to give true general anesthesia
false. any one of those will give general
for IV sedation the ADA requires you to have ________ hrs of instrustion plus management of at least _______pt’s and could result in a moderate sedation permit
60hrs
20 pts
what are the advantages for IV sedation
-Rapid onset of action
-Titration is possible
-Drug reversal (depending on agents used)
-Provides some pain control
-Amnesia a nice side effect
-Control of salivary secretions possible
-Gag reflex diminished
-Motor disturbances (epilepsy, cerebral palsy) diminished
-Having an IV is a benefit in serious emergency situations
what are the disadvantages for IV sedation
Venipuncture is necessary (and can sometimes be difficult)
Venipuncture complications may occur
Iatrogenic damage, hematoma, infection
More intensive monitoring required
Escort is needed
Can lead to general anesthesia
Added cost
what are big problems with IV sedation
Respiratory Depression
Hemodynamic status changes
Laryngospasm
Drug Allergy
Rigid Chest
Aspiration
what are small problems with IV sedation
IV Infiltration
Transient Reactions
Nausea/Vomiting
Histamine Release
Thrombophelbitis
Over-Hydration
T/F with chest wall rigidity or wooden chest syndrome the tx is to use the rescue bag and mask ventilation
false. rescue bag is ineffective.
what is chest wall rigidity usually assoc with? how do you combat it?
too much fentanyl. use naloxone, but you might need to administer a couple of times because half life is smaller
what monitors can you use with IV sedation?
Pulse Oximeter
Non-Invasive Blood Pressure (BP cuff)
EKG
Expired CO2 (end tidal CO2)
Pre-Cordial Stethoscope
morbidity and mortality assoc. with IV sedation is usually the result of ________________
“this will be an exam question”
unrecognized respiratory depression
to be discharged the aldrete score needs to be ________
9 or 10
what should your emergency cart include?
includes resuscitation materials (medications [including reversal agents], oxygen, airways management devices, IV tubing, IV fluids, BLS/ACLS/PALS algorithm cards, etc.)
T/F you should have a defibrillator in the office
true
what sedatives and antianxiety agents can we use?
Benzodiazepines
* Diazepam (Valium)
* Midazolam (Versed)
Barbiturates
* Thiopental
* Methohexital (Brevital)
