Pharm2 9 Anesthesia & Sedation pt4 Flashcards
All agents can be titrated to clinical effect.
What’s the order?
Anxiolysis =>
Conscious Sedation =>
Deep Sedation =>
General Anesthesia
Not too hard, not too soft. Just right. Baby bear that shit.
Explain Synergism to me.
see how it differs from Additive, or Antagonistic.
Remember, synergistic agents must all be where for it to work at max effect?
When combine agents, agents act to potentiate each other’s effects
Additive: 1+1=2
Synergistic: 1+1=3
Antagonistic: 1+1=1.5
Remember agents must be in the central compartment at same time in order to achieve maximal effect
What drug(s)?
7 YO with Angulated Both Bone of the Forearm Fracture
2 minute reduction procedure followed by immediate casting, both requiring anesthesia and total amnesia; this is then followed by a 15 minute wait for repeat x-rays
Midazolam and Ketamine
What is Flumazenil?
Class?
When is it used? Why?
reverse Ketamine.
Flumazenil is benzo receptor antagonist.
Seizure, but this drug blocks Benzo from working. Then you’d give Phenobarbital.
Who would you give Flumanizil to? Nobody. If there’s too much Ketamine let it wear off.
What drug(s)?
16 YO with a Pilonidal Cyst
Exquisitely painful procedure lasting ~ 20 minutes requiring baseline anesthesia and amnesia during the procedure then remaining analgesia
Midazolam and either Fentanyl or Morphine
What drug(s)?
22 YO Football Player with a Shoulder Dislocation
2 minute procedure requiring analgesia, amnesia and, ideally, totally relaxed shoulder muscles
Midazolam & Propofol
What drug(s)?
4 YO Needing CT Scan of Head
2 minute painless procedure requiring anxiolysis only
Consider Dipenhydramine (Benadryl) PO If not successful, advance to Midazolam
What is the peds dosing for Diphenhydramine? (for a painless procedure requiring anxiolysis only)
Prototypical Sedative Antihistamine
Available in tabs, susp, or liquid, also injection
Pediatric Dose: 1.25 mg/kg QID
What drug(s)?
5 YO w/ Pit Bull Attack to Face Requiring Complex Repair
1 hour procedure requiring that the child lay completely still and have a complex, multi-layer closure utilizing baseline analgesia, complete amnesia (including ideally complete retrograde amnesia), and local anesthesia
Midazolam and Morphine perhaps repeating doses throughout procedure, and IM lidocaine locally
Might still use fentanyl even though it doesn’t give retrograde amnesia, instead of midazolam. (next best choice if Midazolam isn’t a multiple choice answer on exam)
What drug(s)?
28 YO: PSVT Needing Cardioversion
10 second procedure requiring analgesia and amnesia
Midazolam & Propofol.
Maybe a little fentanyl too.
But if you use 3 meds, u have to use less of each one.
Best option?
66 YO w/ Colle’s Fracture
You’ve already tried a hematoma block (what’s this?) and 8 attempts to set the wrist in the ED unsuccessfully
Operating Room
Hematoma block - Thru skin, into fracture site, inject lidocaine directly into fracture. Gentle to numb and reduce fracture.
At this point you won’t try anything more in the ED.
In the future, there will be ___ to know the best anesthetic for whoever. based on their receptors.
Genomics
Post Procedure Instructions (5)
Stress clear fluids, ice pops (light foods)
Escort to accompany patient home
Stay on schedule or chronic medications unless otherwise instructed
Do not drive, drink, climb or operate machinery for 24 hours
Remain in the company of a responsible adult for 24 hours
Criteria to discharge a patient post-anesthetic/sedative procedure (5)
Oriented, able to ambulate with steady gate
Vital signs return to baseline
No nausea or bleeding and pain controlled
Tolerate PO intake - especially critical for pediatrics, diabetics. do not force fluids if nauseated; this will only make the situation worse
Have a plan if patient must return
