Sedation/Anaesthesia In ECC

Question 1

In what scenarios might a patient need sedation/anaesthesia in the critical environment?

Answer 1

Respiratory emergencies (calming, facilitate diagnostics)
Urethral obstruction (GA best to facilitate catheterisation)
Surgery (GA with minimal premedication)
Fractious patient

Question 2

What pathway for escalation of sedatives might be a good idea?

Answer 2

Opiods (usually quite safe)
ACP (contraindicated for hypovolaemia, try and avoid in CV disease unless stress is going to cause more harm)
Ketamine (contraindicated in HF especially HCM

Question 3

What precautions could one use to minimise the risks of using propofol as a sedative?

Answer 3

Slow administration

Have an ET tube and Laryngoscope handy!!

Question 4

Through what mechanism does ACP have its adverse effects?

Answer 4

a1 antagonism causing vasodilation and resulting hypovolaemia.

Therefore try to avoid in hypovolaemic states and CV disease

Question 5

What are the effects of ketamine on the MBS?

Answer 5

CV - central sympathomimetic increases HR, vasoconstriction and BP in a healthy heart but at the expense of increased myocardial O2 demand. Has a direct -ve inotropic effect
Resp - initial depression and bronchodilation. Depression is minimal and transient
CNS - dissociative, increases metabolism, cerebral flow and ICP

Question 6

Effects of propofol that may be negative?

Answer 6

Vasodilation with suppression of baroreceptor reflex so HR will not increase