Sedation & Analgesia Flashcards
ASA Grades
Classification Definition
ASA I A normal healthy patient
ASA II A patient with mild systemic disease
ASA III A patient with severe systemic disease
ASA IV A pt w/ severe systemic disease that is a constant threat to life
ASA V Moribund pt w/ multi organ failure or haemodynamic compromise
ASA VI A Pt declare brain dead, awaiting organ harvesting
Procedural sedation indications
- Orthopaedic procedures
- DC Cardioversion
- Any procedure that the patient may find painful or unpleasant
Reversal agent for Opioid overdose
Flumazenil
Morphine dose / Onset time / Peak time / Duration
- 0.1 - 0.2 mg/kg
- 5-10 min onset
- 10-15 minute peak
- 2-4 hour duration
Fentanyl dose / Onset time / Peak time / Duration
- 1-2 mcg/kg
- 1-2 min Onset
- 2-5 min peak
- 30 min duration
Propofol properties
- Sedative
- Amnesic
- No analgesic properties
- 30-60s onset
- Peak 1-2 mins
- Decreased muscular tone
- Resp / CVS depression
- Vasodilation
- Anti-Ionotropic
- Hypotension
- Dose = 0.5 - 1mg/kg
Midazolam properties
- Sedation
- Amnesic
- No analgesic properties
- Decreased muscle tone
- Onset 1-2 mins
- Peak 3-4 mins
- Duration 30 mins
- CVS/Resp depression
- Risk of hypotension but less than propofol
- Dose = 1-2mg
- Top up 0.5mg
Ketamine properties
- Dissociative sedative
- Analgesic
- Amnesic
- CVS/Resp preservation
- Sympathetic response (Tachy, Hypertension, Laryngospasm, Emergence phenomena)
- 1mg/kg
- 1/4 - 1/2 dose top up
- Onset 1min
- Peak 2min
- Duration 30min
What monitoring does ASA advise for a moderate sedation?
- ECG
- NIBP (on 3 min cycles)
- SPO2
- Waveform ETCO2*
- Recommended for moderate sedation
- Mandatory for deep sedation
What does RCEM list as a never event for procedural sedation?
Overdose of Midazolam due to the selection of a higher dose preparation, instead of the 1mg/ml presentation
Clinical assessment and minimum monitoring standards for the anaesthetised patient
Clinical assessment:
- Respiratory rate
- Pulse rate and strength
- CRT / peripheral perfusion
- pupillary size and reactivity
- lacrimation and sweating
- evidence of respiratory effort or limb movement
Minimum standards of monitoring:
- SPO2
- Waveform capnography
- 3-lead ECG
- NIBP
Objectives of analgesia
- To relieve suffering
- To improve assessment
- To reduce physiological stress and prevent deterioration
- To facilitate treatment that would otherwise cause significant distress
Practice recommendations on prehospital pain management from the National Association of EMS Physicians and endorsed by the UK military
- Mandatory assessment of both presence and severty of pain
- Use of reliable tools for the assessment of pain
- indications and contraindications for prehospital pain therapy
- non-pharmacological interventions for pain management
- pharmacological interventions for pain management
- Mandatory patient monitoring and documentation before and after
analgesic administration - Appropriate handover and transfer of care to hospital
- Quality improvement and management structure to ensure appropriate use of prehospital analgesia
Non-Pharmalogical analgesic interventions
- Distraction
- Reassurance
- Immobilisation
- Cold water & dressing in burns
Entonox separates into its components at what temperature?
-6 degrees Celsius
