Sedation technique Flashcards
What are the advantages of IV sedation?
When performed correctly, it is much safer than GA
Patients generally feel a dramatic reduction in anxiety
Patients are generally more compliant with treatment
Treatment can be easier due to reduced need to manage anxiety of patients
Patients forget most unpleasant experiences (IVS only).
Are patients unconscious during sedation?
No, they are conscious. They are unconscious during GA.
What are the different stages in IV sedation care?
1) Pre sedation assessment which will have been completed at a separate visit
2) Pre-operative checks
3) Pre-operative preparation (clinician, drugs and patient)
4) IV access (if no IV access then no IV sedation)
5) Sedation
6) Clinical procedure (active monitoring starts BP/HR/02 sats)
7) Recovery
What are the pre-operative checks?
Escort present and appropriate - no dependants present, escort must be able to physically support the patient
Any medical history changes
Consent appropriate and up to date
Baseline observations recorded - general appearance, BP, pulse, RR, O2 sats
Describe the pre-operative preparation steps to be carried out by the clinician
Do you have equipment required to complete the procedure?
Are you competent to carry out the procedure?
Are the relevant investigations available?
Complications - have you planned for them?
Describe the pre-operative preparation steps to be carried out by the patient
Ensure:
Pre-op checks arewithin acceptable limits* BP, HR, Sats
Pre opBM check done if required
Fasted as appropriate
Topical skin anaesthesia if required
Check they don’t need a toilet break
They know exactly whatis plannedfor this session
Describe the pre-operative preparation to be carried out for the drugs
Protective wear, hand washing
labelsyringes
Check drug type*,concentration and expiry date
LDI we preferentially use 1mg/ml Midazolamconcentration
Draw upsaline and midazolam into appropriately labelled syringes
What are the advantages of the using the antecubital fossa to cannulate?
- Less vulnerable to vasoconstriction in cold weather
- Usually bigger and well tethered veins – easier to cannulate
- May be less painful than dorsum of the hand
What are the disadvantages of the using the antecubital fossa to cannulate?
- Veins may be less visible (particularly with increased BMI)
- Brachial artery and median nerve are medial to biceps tendon
- It may be less obvious if the cannula is incorrectly placed
What are the advantages of the using the dorsal of the hand to cannulate?
- Veins tend to be more visible
- Not likely to damage important vessels or nerves
- May be more obvious if cannula is incorrectly placed
What are the disadvantages of the using the dorsal of the hand to cannulate?
- Vulnerable to vasoconstriction in cold weather
- Usually smaller and more mobile veins – harder to cannulate
- Tends to be more painful
What steps are involved when sedation the patient?
-Check observations before commencement.
-Make sure the syringe is firmly attached to the cannula.
-Start the timer.
-Give 1mg of midazolam iv slowly and wait to observe the effect (0.5mg for elderly, young or ill).
-Titrate the dose against the clinical effect – this will vary person to person.
-Give additional 1mg increments as required.
-Wait one minute between each increment- more if concerns.
-Be patient, converse with the patient throughout.
-If there is no or little effect, double check the cannula site.
-Always flush with saline after the last increment.
What signs should you look for to assess if the patient is compliant for you to start treatment?
-Relaxed demeanour
-Delayed response to questions
-Slurred speech
-Comfortable about starting treatment
-Itchy nose and leg over
-EVE’s sign – nose touching
-Verrill’s sign – pupil partially cloaked
What steps should be followed during the recovery period?
-DO NOT normally reverse the drug- this is bad practice.
-Leave cannula in place until ready for discharge, all observations should be normal for the patient.
-Usually minimum of 1 hour after last increment of midazolam.
-Ensure patient is able to stand and walk unaided.
-Give post-operative verbal and written instructions to escort .
