Sedation

Question 1

midazolam preparation

Answer 1

5mg/5ml

Question 2

midazolam is metabolised in….

Answer 2

the liver

Question 3

midazolam half life

Answer 3

90-150 mins

Question 4

how to treat midazolam over sedation

Answer 4

Flumanezil
500mcg in 5ml

Question 5

flumazenil dose

Answer 5

200mcg then 100mcg increments every 60 seconds until a response is seen

Question 6

fumazenil downsides

Answer 6

shorter half life than midazolam
- 50 mins
risk of re-sedation

Question 7

over sedation - signs and symptoms

Answer 7

loss of responsiveness
respiratory depression
loss of ability to maintain airway
respiratory arrest

Question 8

management of respiratory depression

Answer 8

check oximeter
stimulate patient
- ask them to breathe
supplemental oxygen
- nasal cannula 2 litres per minute
reverse with flumazenil

Question 9

Effects of benzodiazepines

Answer 9

respiratory depression
- CNS depression and muscle relaxation
reduced blood pressure by muscle relaxation decreasing vascular resistance
- increase heart rate due to baroreceptor reflex

Question 10

benzodiazepines side effects

Answer 10

drug interactions
- other CNS depressants
- erythromycin
- antihistamines
tolerance
dependence
sexual fantasies

Question 11

IV sedation procedure

Answer 11

cannulation
pulse oximeter
BP monitoring
drug administration
- 2mg bolus
- 1mg increments every 60 seconds
- until suitable level of sedation

Question 12

iv sedation - signs patient is adequately sedated

Answer 12

slurring and slowing of speech
relaxed
delayed response to commands
willingness to accept treatment