Sedation Flashcards
midazolam preparation
5mg/5ml
midazolam is metabolised in….
the liver
midazolam half life
90-150 mins
how to treat midazolam over sedation
Flumanezil
500mcg in 5ml
flumazenil dose
200mcg then 100mcg increments every 60 seconds until a response is seen
fumazenil downsides
shorter half life than midazolam
- 50 mins
risk of re-sedation
over sedation - signs and symptoms
loss of responsiveness
respiratory depression
loss of ability to maintain airway
respiratory arrest
management of respiratory depression
check oximeter
stimulate patient
- ask them to breathe
supplemental oxygen
- nasal cannula 2 litres per minute
reverse with flumazenil
Effects of benzodiazepines
respiratory depression
- CNS depression and muscle relaxation
reduced blood pressure by muscle relaxation decreasing vascular resistance
- increase heart rate due to baroreceptor reflex
benzodiazepines side effects
drug interactions
- other CNS depressants
- erythromycin
- antihistamines
tolerance
dependence
sexual fantasies
IV sedation procedure
cannulation
pulse oximeter
BP monitoring
drug administration
- 2mg bolus
- 1mg increments every 60 seconds
- until suitable level of sedation
iv sedation - signs patient is adequately sedated
slurring and slowing of speech
relaxed
delayed response to commands
willingness to accept treatment
ASA I
normal healthy patient
non-smoker
minimal alcohol
may be treated in primary care
ASA II
mild systemic disease
may be treated in primary care
ASA III
Severe systemic disease
- limits activity but not incapacitating
should be treated in secondary care
ASA IV
severe systemic disease; constant threat to life
must be treated in secondary care
ASA II examples
current smoker
pregnancy
well controlled diabetes
obesity
ASA III examples
insulin dependent diabetic
stable angina
morbid obesity BMI >40
ASA IV examples
Severe COPD
BP > 200/115
unstable angina
When can the patient leave following procedure?
60 minutes following last increment
what must you do before patient leaves the surgery following treatment?
remove canula
ensure patient can walk unaided
give written post op instructions to escort
Iv sedation pre-op instructions
do not smoke 24 hours prior
no alcohol or recreational drugs 48 hours prior
avoid tablets that may cause drowsiness
do not eat or drink within 2 hours before appointment - eat a light meal at least 4 hours before
must be accompanied by a responsible adult - advisable to go home in a car or taxi
arrange suitable childcare for 24 hours after appointment
do not drive to appointment
iv sedation post op instructions
no breast-feeding for 24 hours
should be taken home by escort
avoid public transport
avoid going out alone, no driving or operating machinery for 24 hours
do not smoke or drink alcohol for 24 hours
do not work for 24 hours
