Sedation Flashcards
Indications for IS
- Anxiety
- Needle phobia
- Gagging
- Med conditions aggravated by stress
Contraindications for IS (4)
- Pregnant 1st trimester
- Blocked nose
- Fear of mask (claustrophobia)
- COPD
Safety features (7)
- O2 monitor
- One way expiratory valve
- Scavenging system
- Colour coding
- Pressure reducing valve
- Reservoir bag
- O2 and NiO pressure dials
Advantages of IS (7)
- Rapid onset
- Rapid peak action
- Rapid recovery
- Flexible duration
- Drug not metabolised
- No amnesia
- No injection for sedation
Disadvantages of IS (5)
- Equipment expensive
- Gases expensive
- Requires ability to breathe through nose
- Requires pt cooperation
- Difficult to accurately determine dose
Signs of adequate sedation (6)
- Pt relaxed
- Aware
- Decreased blinking rate
- Gag reflex obtunded
- Verbal contact remains
- Mouth open on request
Signs of over sedation (6)
- Mouth closed repeatedly
- Nausea/vomiting
- Irrational sluggish response
- Incoherent speech
- Uncontrollable laughter
- Decreased cooperation
Pre-op instruction for sedation (4)
- Light meal
- Children accompanied
- No alcohol
- Plan to remain for up to 30mins post tx
What is the 2,4,6 rule?
2 clear fluids
4 breast milk
6 solids
Give an example of an oral pre-med for anxiety/sleep
Benzodiazepine
Drug used for IS
Nitrous oxide
Drug used for IV
Midazolam
How to reverse over-sedation
Flumazenil 200ug –> 100ug increments
If allergic reaction = NO FLUMAZENIL
Signs/symptoms of Nitrous oxide overdose
Lack of cooperation
Slurring speech
Vomiting
Uncontrollable laughter
Loss of consciousness
Management of NiO overdose
Decrease nitrous oxide concentration by 5-10%
Do not remove nose piece - diffusion hypoxia
Advantages of IS
Rapid onset
Rapid recovery
Rapid action
No amnesia
Not metabolised
No injection required for sedation
IV advantages
Less cooperation
Muscle relaxant
IV disadvantages
Baseline readings
IV cannulation required
Indications for IS
Anxiety
Needle phobia
Med conditions aggravated by stress: asthma, epilepsy, hypertension
Med conditions aggravated by cooperation: parkinsons/learning difficulties
IS Contraindications
COPD
Blocked nose
Pregnancy - 1st trimester
IV contraindications
COPD
Pregnancy/lactating
Hepatic insufficiency
Intracranial pathology
Younger than 12
Safety features
Pressure reducing valve
One way expiratory valve
Scavenging system
Nio + O2 pressure dials
O2 monitor
Reservoir bag
Complications of cannulation
Venospasm - dissapearing veins, warm water
Extravascular injection - test with saline
Haematoma - avoid multiple perforations
Fainting - eat before
What are the ASA classifications?
I - healthy
II - mild systemic disease social drinker/ obese
III - moderate systemic disease - poorly controlled diabetes
IV - severe systemic threat to life
V - moribund
VI - brain dead
What is a healthy BMI?
18-24.9
What is an overweight BMI?
25-29.9
What is an obese BMI?
> 30
