PROCEDURAL SEDATION

Question 1

Definition of Sedation

Answer 1

“a state of reduced excitement or anxiety that is induced by the administration of a sedative agent”

Question 2

Definition of General Anesthesia

Answer 2

“a state of total unconsciousness resulting from an anesthetic drug”

Question 3

Definition of Dissociation

Answer 3

“state of mind body separation”

Question 4

List Pre-Procedural Assessment

Answer 4

Assess the urgency of the situation
Assess the risks of the patient
Assess the difficulty of the procedure
Assess the environment and the personel available

Question 5

Risk Strategy a patient

Answer 5

Extremes of age
Pregnant
Sick
Difficult ventilation / Intubation
Drugs / EtOH
Previous difficulties with sedation
Planned deep sedation

Question 6

Pertinent Documentation of Patient Risks

Answer 6

NPO Status
Abnormalities of Major Organs (ASA)
Previous Sedation / Anesthetic History
Medications and Allergies
EtOH, tobacco, Illicit Drugs
Obstructive Sleep Apnea

Question 7

Risk Factors for difficult Bag Mask

Answer 7

Beard / Facial Deformity
Old
Obesity
Toothless (adentulous)
Spine mobility
Sounds: snoring, stridor

Question 8

Risk Factors for difficult intubation

Answer 8

Look for external features
Evaluate 3-3-2
Mallampati
Obstructoin
Neck Mobility
Scene and Situation

Question 9

List the traditional fasting guidelines

Answer 9

2 hrs for clear fluids
6 hrs for light breakfast
8 hrs for all other meals

Question 10

Important Documentation for Precedural Sedations

Answer 10

Patient Risk Factors
Consent for Sedation
Written Discharge Instructions

Question 11

List the most important discharge instructions

Answer 11

Ascertain escort
No driving for 24 hrs
Written Instructions
Sleep Apnea - prolonged observation, CPAP required

Question 12

List the things needed for procedural sedation

Answer 12

“SOAP-ME”
Suction
Oxygen:
• Nasal Canula
• Non-Rebreather
• Bag Valve Mask
Airway
Pharmacology:
• Induction Agent: Ketamine, Propofol
• Paralytic Agent: Rocuronium
• Pressors: Phenylephrine
Monitoring: Cardiac and Saturation
Equipment:
• Laryngoscope – direct vs. video (no. 3 or 4; 7.5 mm – F, 8 mm – M)
• Endotracheal Tube (F: 7.5-8.0, M: 8.0-8.5)
• End-tidal C02 Device (colorimetric vs. quantitative)
• Ventilator
• Intubation adjuncts – bougie, OPA / NPA

Question 13

List the things documented during Intra-Procedural Monitoring

Answer 13

Level of Consciousness
Oxygenation
Capnography
Hemodynamics

Question 14

What is the most important parameter to monitor during procedural sedation?

Answer 14

Capnography