7. Procedural Sedation and Analgesia Flashcards
(39 cards)
What are the 3 major body systems involved in procedural sedation?
- cardio<br></br>2. resp<br></br>3. cns
Anxiolysis defn
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<div> state of decreased apprehension concerning a particular
situation in which the patient’s level of awareness does not change. </div>
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Analgesia defn
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<div>relief of pain without the intentional alter-
ation of mental status, such as occurs in sedation. An altered
mental state may be a secondary effect of the medications
administered for this purpose. </div>
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Dissociation defn - related to procedural sedation
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<div>trancelike cataleptic state induced by an agent such
as ketamine and characterized by analgesia and amnesia. Pro-
tective reflexes, spontaneous respirations, and cardiopulmonary
stability are retained. Sedation is a controlled reduction of envi-
ronmental awareness. </div>
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What is the defn of procedural sedn and analgesia?
technique of administering sedative/dissoc agent, along with an analgesic to induce a state allowing pt to tolerate a painful procedure while maintaing spont cardioresp function
ASA 4 supgroups for procedural sedation:<br></br>1. minimal sedation
“anxiolysis” - drug induced state which pt respond N to verbal commands<br></br>cogn and coord impaired but vent and cv not
ASA 4 supgroups for procedural sedation:<br></br>2. moderate sedation and analgesia/”conscious sedation”
drug induced depression of consciousness - purposeful repsonse to verbal commands, auditory only or w light tactile stim<br></br>no intervention to maintain airway with spont ventil<br></br>cardiovascular function maintained
ACEP 5th group: of 4 ASA supgroups for procedural sedation:<br></br>3. dissociative sedation
cataleptic state inducd by ketamine - analgesia and amnesia while airway reflxes are normal, spont resps with cardipulmonary stability
ASA 4 supgroups for procedural sedation:<br></br>3. Deep sedation and analgesia
pt cannot be increased consciousness despite repeated/painful stim<br></br>may have impaired vent function on own<br></br>may need help with ventil<br></br>cv function maintained
ASA 4 supgroups for procedural sedation: <br></br>4. General anesthesia
drug induced LOC during which pt not arousable even to stim<br></br>ventil own is impaired<br></br>require airway assitance and PPV given decr NM function<br></br>CV function may be impaired
Pure sedative example meds - 3
benzo<br></br>etomidate<br></br>propofol<br></br><br></br>all act on GAba
Dexmeditomidine: MOA procedural sedation wise
acts on alpha 2 adrenoreceptors<br></br>sedation and mild analgesia
How does ketamine work?
analgesia, dissoc agent<br></br>antagonist of NMDA receptor
What components to decide to go ahead with procedural sedation are important?
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<div>patient assessment, including the consideration
of preprocedural fasting, appropriate personnel, supplies, and equip-
ment, patient monitoring, and postprocedural recovery. </div>
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What pt are higher risk for procedural sedation?
- extremes of age<br></br>2. ROMAN or LEMONS + bmv or intub dif<br></br>3. underlying disease state<br></br>4. impaired cardiopulmonary physiology
Hx for procedural sedation: important points?
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<div>atient’s age, current illness or injury for which PSA is intended,
comorbidities, previous experiences or problems with PSA or general
anesthesia, drug allergies and current medications, and tobacco, drug,
and alcohol use are reviewed and recorded </div>
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PE for procedural sedation: key points?
VS<br></br>heart and lungs<br></br>ROMAN, LEMONS, RODS, SMART
What ASA score level pt are appropriate for procedural sedation?
asa 1, 2
Who do you need to do procedural sedation?
- person to focus on pt and vitals<br></br>2. person to do sedation
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oversedation
resp depression
cardiopulmonary arrest
-capnography for etco2
-rescue epi for anaphylaxis and cardiopulmonary arrest
-MR SOPA related = monitors, repos head with oral airway, suction, oxygen, lma/ett
+ vascular access equipment
- follow commands, speech, ambulation, sitting
vs and resp status
nausea minimal, no vomit
no driving or other hgih risk activities 12-24 hours
