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sedation Flashcards

1
Q

why is midazolam very safe for conscious sedation?

A 
0.5mg = sedated
25/30g = anaesthetised
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2
Q

3 medical conditions that would benefit from sedation

A

ischaemic heart disease, hypertension, asthma

all aggravated by stress - but have to balance risk

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3
Q

why can’t you sedate very old

A

liver + kidney compromised metabolism

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4
Q

why can’t you sedate very young

A

sensitive to dosage

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5
Q

medical contraindication for sedation

A

severe + uncontrolled systemic disease - especially cardio-resp e.g. MI, COPD
hepatic or renal insufficiency
pregnancy + lactation

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6
Q

how long should sedation treatments take max

A

40mins

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7
Q

what happens if pt takes antihypertensive and is sedated with midazolam

A

high drop in BP

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8
Q

what drug has extreme risk of respiratory depression with midazolam

A

antiviral agent’s - ritonavir

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9
Q

4 vital signs needed for sedation

A

pulse
BP
resp rate
BMI

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10
Q

what is the classification used to assess fitness for sedation

A

ASA

I = without systemic disease
II = mild systemic disease
III = moderate systemic disease, limits activity
IV = incapacitating systemic disease - constant threat t life
V = not expected to survive 24hrs
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11
Q

what type of sedation is CI in pregnancy

A

IV - midazolam passes placenta

inhalation ok

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12
Q

describe ASA1

A

normal healthy patient <60yrs
minimal anxiety
BP <140/90

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13
Q

decribe ASA2

A 
any healthy patient >60yrs
heathy but phobic, overweight, pregnant or special needs
BP <160/95
drug allergy
mild controlled systemic disease
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14
Q

describe ASA3

A 
well controlled insulin diabetes or epilepsy
poorly controlled asthma
stable angina 
post MI or cerebrovascular accident  >6/12
chronic bronchitis or emphysema 
congestive heart failure 
thyroid disease
BP <200/115
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15
Q

describe ASA4

A 
poorly ontorlled insulin diabetes or epilepsy
unstable angina
post MI or CVA <6/12
COAD or CHF requiring O2 therapy
uncontrolled dysrhythmias
BP >200/115
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16
Q

which ASA grades can be sedated in GDP

A

ASA1 + 2

higher must be done in hospital

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17
Q

what gauge cannula is used for IV sedation

A

22 - blue

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18
Q

conc of midazolam used in IV sedation

A

5mg/5ml

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19
Q

chemotherapeutic drug that has bad interaction for BDZ

A

methotrexate

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20
Q

2 monitoring techniques used

A

oximeter - oxygen saturation in arterial pressure + pulse

BP monitor

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21
Q

when does consent for treatment expire

A

after 1 year

22
Q

why must patient not have drank alcohol night before/morning of appointment

A

alcohol + midazolam = synergistic effect

23
Q

what can patients eat before sedation

A

light meal

24
Q

technique for inserting midazolam

A

1mg injected slowly
wait 1 min
1mg every minute after
2-5mg/l in total

25
arm brain circulation time?
25 seconds
26
5 signs of sedation
1. slurring/slowing of speech 2. relaxed appearance 3. delayed response to commands 4. ptosis 5. willingness to undergo treatment
27
how long after should arterial saturation be measure for
1 hour
28
5 complications of IV sedation
1. respiratory depression - decreased O2 conc 2. over-sedation 3. disinhibition - react in complete opposite way expected 4. medical emergency - not epilepsy 5. allergy
29
what is used to reverse midazolam
flumazenil 200ug initially | 100ug/min max
30
2 possible sites for cannulation
1. dorsal vein of hand - no vital structures | 2. antecubital fossa - large veins, danger of brachial artery + median nerve, problems with joint movement
31
what is used to irrigate cannula + check in correct position
5ml 0.9 sterile saline - 18g needle
32
where is tourniquet positioned
10cm above cannula
33
what angle is cannula inserted
10-15
34
4 complications of cannulation
1. difficult vein - lower arm, warm hands, apply BP cuff, palpate veins 2. extra venous cannulation - pain, formation of subcutaneous lump, resite 3. intra-arterial injection - avoid medial antecubital fossa, signicatn pain, pulsatile blood, remove, pressure +/- refer 4. haematoma formation - avoid multiple venipuncture, avoid penetrating wall of vein, pressure after
35
2 types of unit for inhalation sedation
1. stand alone | 2. piped in
36
colour of nitrous oxide cylinder
blue
37
colour of oxygen cylinder
black
38
4 components of quantify MDM head
1. flow meter 2. % dial 3. flow regulator 4. oxygen flush button
39
what is a scavenging unit
activity removed exhaled gases - long term exposure can be detrimental
40
2 types of mask system for inhalation sedation
1 mask or 2 mask (NDH)
41
what would happen if 100% nitrous oxide given
patient become hypoxic - many safety features to ensure this doesn't happen
42
define inhalation sedation
semi-hypnotic technique of conscious sedation which enhance pt suggestibility pt reamins cooperative with all vital reflexes intact
43
advantages of inhalation sedation
``` rapid onset 2-3mins rapid peak 3-5mins easily regaled duration flexible rapid recovery - 3-5mins on 100% O2 moderate anaglesia no injection few side effects ```
44
disadvantages of inhalation sedation
``` cost of equipment space occupying not a potent agent degree of cooperation necessary chronic exposure bad ```
45
contraindications for inhalation sedation
``` claustrophic middle ear/sinus infections ocular surgery URTI severe anxiety pregnancy methotrexate bleomycin therapy ```
46
maximum percentage of n2o + oxgygen
70% N2o 30%o2 start from 100% o2 and titrate by 10 10 10 5 5 5 ... every min
47
how to monitor inhalation sedation
communicate + watch pt
48
signs over slight over sedation in inhalation sedation
hearing more acute, blurred vision, sleepiness, laughing, crying, caused, increased movement
49
signs of over sedation in inhalation sedation
nausea/headache | vomiting/loss of consciousness
50
management of over sedation in inhalation sedation
reduce nitrous oxide by 5-10% pressure pt + monitor encourage to keep o2 mask off
51
cause of vasovagal syncope
vasodilation of vessel going towards skeletal muscles - BP drops not enough CO to maintain blood to brain
52
if pt having MI what may help that is available on sedation clinic
50% n2o 50% o2 increases vasodilation + analgesic

Restorative (10 decks)

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