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Restorative > sedation > Flashcards

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
Q

arm brain circulation time?

A

25 seconds

26
Q

5 signs of sedation

A
  1. slurring/slowing of speech
  2. relaxed appearance
  3. delayed response to commands
  4. ptosis
  5. willingness to undergo treatment
27
Q

how long after should arterial saturation be measure for

A

1 hour

28
Q

5 complications of IV sedation

A
  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
Q

what is used to reverse midazolam

A

flumazenil 200ug initially

100ug/min max

30
Q

2 possible sites for cannulation

A
  1. dorsal vein of hand - no vital structures

2. antecubital fossa - large veins, danger of brachial artery + median nerve, problems with joint movement

31
Q

what is used to irrigate cannula + check in correct position

A

5ml 0.9 sterile saline - 18g needle

32
Q

where is tourniquet positioned

A

10cm above cannula

33
Q

what angle is cannula inserted

A

10-15

34
Q

4 complications of cannulation

A
  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
Q

2 types of unit for inhalation sedation

A
  1. stand alone

2. piped in

36
Q

colour of nitrous oxide cylinder

A

blue

37
Q

colour of oxygen cylinder

A

black

38
Q

4 components of quantify MDM head

A
  1. flow meter
  2. % dial
  3. flow regulator
  4. oxygen flush button
39
Q

what is a scavenging unit

A

activity removed exhaled gases - long term exposure can be detrimental

40
Q

2 types of mask system for inhalation sedation

A

1 mask or 2 mask (NDH)

41
Q

what would happen if 100% nitrous oxide given

A

patient become hypoxic - many safety features to ensure this doesn’t happen

42
Q

define inhalation sedation

A

semi-hypnotic technique of conscious sedation which enhance pt suggestibility
pt reamins cooperative with all vital reflexes intact

43
Q

advantages of inhalation sedation

A 
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
Q

disadvantages of inhalation sedation

A 
cost of equipment
space occupying
not a potent agent
degree of cooperation necessary 
chronic exposure bad
45
Q

contraindications for inhalation sedation

A 
claustrophic
middle ear/sinus infections 
ocular surgery 
URTI
severe anxiety 
pregnancy 
methotrexate
bleomycin therapy
46
Q

maximum percentage of n2o + oxgygen

A

70% N2o 30%o2

start from 100% o2 and titrate by 10 10 10 5 5 5 … every min

47
Q

how to monitor inhalation sedation

A

communicate + watch pt

48
Q

signs over slight over sedation in inhalation sedation

A

hearing more acute, blurred vision, sleepiness, laughing, crying, caused, increased movement

49
Q

signs of over sedation in inhalation sedation

A

nausea/headache

vomiting/loss of consciousness

50
Q

management of over sedation in inhalation sedation

A

reduce nitrous oxide by 5-10%
pressure pt + monitor
encourage to keep o2 mask off

51
Q

cause of vasovagal syncope

A

vasodilation of vessel going towards skeletal muscles - BP drops
not enough CO to maintain blood to brain

52
Q

if pt having MI what may help that is available on sedation clinic

A

50% n2o 50% o2

increases vasodilation + analgesic

Restorative (10 decks)

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