Sedation Flashcards
1
Q
Where are ventilation and perfusion greater in the lung
A
At the base
2
Q
In what position are differences in ventilation and perfusion less marked
A
Prone position
3
Q
Where is nitrous oxide carried through the body
A
Simple solution in blood
4
Q
Common special care patient group for sedation (3)
A
- Involuntary movements
- Learning difficulties
These can both be congenital or acquired
5
Q
Consent for sedation
A
Must be written consent
6
Q
Form allowing sedation treatment for AWI - how long does it last
A
36 months
7
Q
Conscious Sedation Techniques (4)
A
- Inhalation
- Intravenous
- Oral
- Transmucosal
8
Q
Inhalation Sedation Advantages (3)
A
- Anxiety relief
- Rapid recovery
- Flexible duration
9
Q
Inhalation Sedation Disadvantages (3)
A
- Keeping nasal hood in place
- Less muscle relaxation
- Coordination of nasal breathing when mouth open
10
Q
Intravenous Sedation Drug used (2)
A
Midazolam
Propofol
11
Q
Intravenous Sedation Advantages (3)
A
- Good sedation
- Less cooperation needed
- Muscle relaxation
12
Q
Intravenous Sedation Disadvantages (5)
A
- Baseline readings
- IV cannulation
- Assessing sedation level
- Behaviour during recovery
- Efficacy swallowing
13
Q
Intravenous Sedation - Safety (5)
A
- Swallowing
- Airway
- Liver
- Medication interactions
- ASA
14
Q
Oral/Transmucosal Sedation Advantages (4)
A
- Avoids cannulation
- Can make induction more pleasant
- Better cooperation
- Better future behaviour
15
Q
Oral/Transmucosal Sedation Disadvantages (6)
A
- Baseline readings
- Bitter taste/stinging
- Lag time
- Untreatable
- Difficulty monitoring level of sedation
- Behaviour in recovery
16
Q
Complications of cannulation (5)
A
- Venospasm
- Extravascular injection
- Intraarterial injection
- Haematoma
- Fainting
17
Q
What is venospasm
A
Vein collapses at attempted venepuncture
18
Q
What makes venospasm worse
A
Repeated attempts
19
Q
Preventing venospasm (2)
A
- Efficient, quick technique
- Gloves in winter
20
Q
Extravascular injection
A
Drug placed into interstitial space
21
Q
Extravascular injection diagnosis - sedation (2)
A
Pain
Swelling
22
Q
Extravascular injection problems - sedation (2)
A
Delayed absorption
If more drug given, double dosage
23
Q
Extravascular injection prevention (2)
A
Good cannulation
Saline flush
24
Q
Extravascular injection treatment (3)
A
Remove cannula
Apply pressure
Reassure
25
Intraarterial injection diagnosis - sedation (5)
1. Pain on venepuncture
2. Red blood in cannula
3. Difficult to prevent leaks
4. Pain radiating distally from site of cannulation
5. Loss of colour of warmth to limb/weakening pulse
26
Intraarterial injection prevention (2)
Avoid anatomically prone sites - ACF medial to biceps tendon
Palpate before attack
27
Intraarterial injection management (5)
1. Do not give drug
2. Monitor for loss of pulse, cold, discolouration
3. Leave cannula in situ for 5 minutes post drug
4. No problems - remove
5. Symptomatic - leave and refer to hospital (procaine 1%)
28
Haematoma
Extravasation of blood into soft tissues
29
Cause of haematoma (3)
1. Damage to vein walls
2. At venepuncture - poor technique
3. At removal - failure to apply pressure
30
Haematoma Prevention - sedation (3)
Good cannulation technique
Pressure post operatively
Care with elderly
31
Haematoma treatment - sedation (5)
1. Time
2. Rest
3. Reassurance
4. If severe - initial ice pack
5. Consider heparin containing gel
32
Fainting management - sedation (4)
1. Patients should have eaten
2. Topical skin anaesthesia
3. RA first
4. Position patient - if they don't come around with feet up its not a faint
33
Intravenous Sedation - Drug administration complications (5)
1. Hyper responders
2. Hypo responders
3. Paradoxical reactions
4. Oversedation
5. Allergic reactions
34
Allergic reaction to sedation drug
Don't give the reverse - Also a pam and can make reaction worse
35
Hyper responders - sedation (3)
1. Deep sedation with minimal dose
2. 1mg increments
3. Slow titration in elderly
36
Hypo responders - sedation (3)
1. Little sedative effect in large doses
2. Check cannula in vein
3. May be due to tolerance
37
Threshold to abandon sedation
10mg
38
Paradoxical reactions - sedation (4)
1. React extremely to stimuli
2. Check for failure of LA
3. Can do the opposite of sedate
4. Find other management technique
39
Oversedation issues (4)
1. Loss of responsiveness
2. Respiratory depression
3. Loss of ability to maintain airway
4. Respiratory arrest
40
Oversedation management (4)
1. Try to rouse patient
2. ABC
3. If no response to stimulation and support - reverse with flumazenil
4. Watch for 1-4 hours
41
Respiratory depression - management (4)
1. Check oximeter
2. Ask patient to take deep breaths
3. Nasal oxygen cannulae 2L/min
4. Reverse with flumazenil
42
Signs and Symptoms of nitrous oxide overdose (6)
1. Pt discomfort
2. Lack of cooperation
3. Mouth breathing
4. Giggling
5. Nausea/vomiting
6. Loss of consciousness
43
Nitrous oxide overdose treatment (3)
1. Decrease nitrous oxide concentration by 5-10%
2. Reassurance
3. Don't remove nosepiece
44
What can happen if you remove the nosepiece too early in sedation?
Diffusion hypoxia
45
Definition of sedation (3)
1. Drugs produce a state of depression of the CNS
2. Verbal contact with the patient is maintained
3. Margin of safety is wide enough to render unintended loss of consciousness unlikely
46
Deep sedation
Verbal contact with patient not maintained
Regarded as general anaesthesia
47
Medical contraindications for sedation (5)
1. Severe/uncontrolled systemic disease
2. Severe mental/physical disability
3. Severe psychiatric problems
4. Narcolepsy
5. Hyperthyroidism
48
Contraindications for intravenous sedation (5)
1. Intracranial pathology
2. COPD
3. Myasthenia gravis
4. Hepatic insufficiency
5. Pregnancy and lactation
49
Contraindications for inhalation sedation (3)
1. Blocked nasal airway
2. COPD
3. Pregnancy (dentist)
50
Social contraindications for sedation (5)
1. Unwilling
2. Uncooperative
3. Unaccompanied
4. Children (for IV)
5. Very old
51
How old must children be to get IV sedation
> 12
52
Dental contraindications for sedation (4)
1. Procedure too difficult for LA alone
2. Procedure too long
3. Spreading infection
4. Procedure too traumatic
53
Advantages of sedation (3)
1. Decrease stress for everyone
2. Fewer medical incidents
3. More productive appointments
54
Disadvantages of sedation (3)
1. Training required
2. Equipment required
3. Recovery time and after care
55
ASA Class I
A normal healthy patient
56
ASA Class II
A patient with mild systemic disease
57
ASA Class III
A patient with severe systemic disease
58
ASA Class IV
A patient with severe systemic disease that is a constant threat to life
59
ASA Class V
A moribund patient who is not expected to survive without the operation
60
ASA Class VI
A declared brain dead patient whose organs are being removed for donor purposes
61
What should we be competent at on graduation in relation to sedation
Assessment of patients who may go on to have sedation and discussion with them about their options
62
Locations for IV sedation (2)
1. Antecubital fossa
2. Dorsum of hand
63
When should sedation assessment be carried out
On a separate visit to the sedation visit
64
What does a sedation assessment entail (5)
1. History
2. Examination (vital signs)
3. Tx plan
4. Consent
5. Informations for patient and escort
65
SH sedation assessment (5)
1. Nature of fear
2. Phobia vs anxiety
3. Anxiety questionnaire
4. Responsibilities - children?
5. Transport
66
PDH sedation assessment (4)
1. Referral source
2. Previous sedation? Problems?
3. Proposed procedure
4. Symptoms - acute or chronic
67
Drug effects on midazolam
Almost all drugs increase the sedative effect of midazolam
68
If a patient doesn't know what drugs they're on at a sedation assessment what should be done
Seek confirmation
69
What ASA classifications can be treated with sedation in primary care
I and II
70
What ASA classification should be treated in secondary care
III
71
What ASA classification MUST be treated in secondary care
IV
72
What do almost all sedation drugs do to the airway
Respiratory depression
73
Asthma questions for sedation assessment (3)
1. What drugs and how often
2. Have they been hospitalised
3. Exacerbated by stress
74
Predictable interactions between drugs (2)
1. Antidepressants + BDZs
2. Antihypertensives + BDZs
75
Pharmacodynamic interactions definition
Interactions between drugs which have similar or antagonistic pharmacological effects
76
Pharmacokinetic interactions definition
One drug alters the absorption, distribution, metabolism or excretion of another, thereby changing the amount of drug available to produce effects
77
Which is more predictable, pharmacodynamic or pharmacokinetic interactions
Pharmacodynamic
78
Vital signs checked at sedation assessment (4)
1. HR
2. BP
3. Oxygen saturation
4. BMI
79
Ideal working time for sedation
45 minutes
