Sedation

Question 1

Define sedation.

Answer 1

Sedation is a continuum fo states from minimal (axiolysis) to general anaesthesia.

Question 2

What are the four criteria assessed to define the level of sedation?

Answer 2

Responsiveness

Airway

spontaneous ventilation

Cardiovascular Function

Question 3

What are the four phases of sedation?

Answer 3

Minimal sedation (anxiolysis) (buzzed)

Moderate sedation/analgesia (conscious sedation) (wasted)

Deep sedation/analgesia (passed out)

General anaesthsia (ambulance)

Question 4

Using the four criteria, what is the definition of minimal sedation?

Answer 4

Responsiveness: normal response to verbal stimulation

Airway: unaffected

Spontaneous ventiation: unaffected

Cardiovascular system: unaffected

Question 5

Using the four criteria, what is the definition of moderate sedation?

Answer 5

Responsiveness: purposeful response to verbal or tactile stimulation

Airway: no intervention required

spontaneous ventilation: adequate

Cardiovascular function: usually maintained

Question 6

Using the four criteria, what is the definition of deep sedation

Answer 6

Responsiveness: purposeful response following repeated or painful stimulation

Airway: Intervention may be required

Spontaneous ventilation: may be inadequate

cardiovascular function: usually maintained

Question 7

Using the four criteria, what is the definition of general anaesthesia?

Answer 7

Responsiveness: unable even with painful stimuli

Airway: intervention often required

Spontaneous ventilation: frequently inadequate

cardiovascular function: may be impaired

Question 8

What are Guedel’s 4 stages of general anaesthesia

Answer 8

There are four stages of general anesthesia:

Stage 1: analgesia

Stage 2: excitement

Stage 3: surgical anesthesia

Stage 4: imminent death

Question 9

Guedel’s Scheme- stages of anaesthesia

What are the signs that your sedation is deeper than minimal sedation (stage 1)?

Answer 9

signs and symptoms for excitement- stage II

Abnormal respiration

eyes divergent

dilated pupils

impaired blink reflex

disinhibited movement

Question 10

ASA Classifications

Answer 10

ASA I: A normal, healthy patient
ASA II: A patient with mild systemic disease or significant health risk factor
ASA III: A patient with severe systemic disease that is not incapacitating
ASA IV: A patient with severe systemic disease that is a constant threat to life
ASA V: A moribund patient who is not expected to survive without the operation
ASA VI: A declared brain-dead patient whose organs are being removed for donor purposes

Question 11

Perioperative setup: TREAT

define

Answer 11

Team present: ASA standards

-deep or pediatric sedation: 3 members present (1 ACLS and 2 BLS)

(pediatric is 12 yrs and under)

-2 persons mild/moderate sedation (

Rescue drugs: Flumazenil/Noxalone/Succinylcholine

Empty/Escort: NPO ASA standard;

Question 12

What is the one risk that all providers must be prepared for when prescribing sedation at any level?

Answer 12

When prescribing sedation- each provider must be prepared for the patient becoming sedated to a deeper level than intended and know how to rescue that patient.

Question 13

What is the ASA guidelines regarding Propofol, methohexital (barbiturate) and Ketamine?

Answer 13

patients receiving Propofol and methohexital are considered deep sedation and should receive care consistent with deep sedation.

Ketamine: care consistent with the level of sedation achieved.

Question 14

What doesn’t define a sedation plane?

Answer 14

Drugs (except Propofol and Ketamine- they have specific policy)

Airways used (LMA’s/ETT’s)

Question 15

What are the guidelines regarding enteral drugs, inhalation drugs and staying within the minimal sedation phase?

Answer 15

Any enteral drug exceeding the maximum recommended dose in a single visst= moderate sedation.

More than 1 enteral drug= moderate sedation

1 enteral drug + N2O= moderate sedation.

Question 16

How many cases of sedation/N2O are you required to have annually to maintain your credentials?

Answer 16

10

Question 17

What is required (policy) when using N2O 51% or greater?

Answer 17

Both operators be BLS certified

MTF approved sedation and anaesthesia record- patient monitoring

to include: BP and pulse oximeter q 15 mins

DA 4700 Front (system focused health hx)

DA4700 Back verification of any changes at time of surgery

(50% or below- no requirement for patient monitoring)

Question 18

Requirements for DAs and sedation

Answer 18

Annual competency assessment

BLS certification

annual training- ie: management of sedated patients; med emergency and response training

Question 19

What is the Mallampati Scale?

Answer 19

Question 20

What is the Brodsky tonsil grading scale.