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Sedation Symposium > Complications of Conscious Sedation > Flashcards

Complications of Conscious Sedation Flashcards

1
Q

what drug is used in IHS

A

nitrous oxide

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2
Q

what drug is used in IVS

A

midazolam

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3
Q

what is conscious sedation

A

a technique in which the use of a drug or drugs produces a state of depression of CNS

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4
Q

what complications can arise from cannulation

A

venospasm
extravascular injection
intraarterial injection
haematoma
fainting

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5
Q

what is venospasm

A

where the veins collapse at attempted venepuncture

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6
Q

how do you manage venospasm

A

take time to dilate the vein (with tourniquet and gravity)
use efficient technique
wear gloves in winter (for patient before they come in)

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7
Q

what is extravascular injection

A

where the active drug is placed into interstitial space

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8
Q

how do you diagnose extravascular injection

A

if there is pain and swelling present

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9
Q

what is the problem associated with extravascular injection

A

delayed absorption

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10
Q

how do you manage extravascular injection

A

prevent by good cannulation and saline wash
treat by removing cannula, applying pressure and reassuring patient

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11
Q

how do you diagnose intra-arterial injection

A

pain on venepuncture
red blood in cannula
difficult to prevent leaks
pain radiating distally from site of cannulation
loss of colour or warmth to limb/weakening pulse

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12
Q

how do you prevent intra-arterial injection

A

avoid anatomically prone sites
palpate before

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13
Q

how do you manage intra-arterial injection

A

monitor for loss of pulse
leave cannula in situ for 5 mins post drug
remove if no issues
if symptomatic refer to hospital

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14
Q

what is a haematoma

A

extravasation of blood into soft tissues due to damage to vein walls

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15
Q

when does haematoma occur

A

at venepuncture due to poor technique
removal of cannula if fail to apply pressure

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16
Q

who is more prone to haematoma

A

elderly

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17
Q

how do you prevent a haematoma from occurring

A

good cannulation technique
pressure post operatively
take care with elderly

18
Q

how do you treat a haematoma

A

time
rest
reassurance
if severe - ice pack

19
Q

why do people faint during sedation

A

anxiety related to venepuncture
not eaten

20
Q

how do you prevent fainting

A

dont starve patient
topical skin anaesthesia first to calm them
position patient sitting down

21
Q

what are the complications of drug administration

A

hyper-responders
hypo-responders
paradoxical reactions
oversedation
allergic reactions

22
Q

what are hyper-responders

A

people who are deeply sedated with minimal dose (1-2mg midazolam)

23
Q

how do you deal with hyper-responders

A

take care with titration
give 1mg increments
titrate slowly in elderly

24
Q

what is a hypo-responder

A

little sedative effect with large doses

25
Q

how do you deal with a hyporesponder

A

check cannula is in vein
abandon at certain threshold

26
Q

what type of people could be hyporesponders

A

benzodiazepine users who have built up a tolerance

27
Q

what is a paradoxical reaction

A

appear to sedate normally but actually are not sedated
these people react extremely to all stimuli

28
Q

how do you manage a paradoxical reaction

A

check for failure of LA
dont add more sedative
find other management techniques

29
Q

what is oversedation

A

loss of responsiveness
respiratory depression/arrest

30
Q

how do you manage oversedation

A

stop procedure
try to rouse patient
ABC
if no response to stimulation and support reverse with flumazenil 200ug and then 100ug increments at minute intervals
watch for 1-4hrs

31
Q

how do you manage respiratory depression

A

check oximeter
stimulate patient and ask to breathe
give supplemental oxygen through nasal cannula
reverse with flumazenil

32
Q

how much oxygen is given to a patient through a nasal cannula

A

2l per min

33
Q

how do you manage an allergic reaction to midazolam

A

DO NOT USE FLUMAZENIL
use adrenaline IM

34
Q

how do you manage incidences of sexual fantasy with sedated person

A

ensure the patient is chaperoned at all times

35
Q

what are the complications of inhalation sedation

A

oversedation
patient panics

36
Q

how can oversedation occur in IHS

A

misjudge the dose
procedure is over but mouth breathing ceases

37
Q

what are the signs and symptoms of N2O overdose

A

patient discomfort
lock of co-operation
mouthbreathing
giggling
nausea
vomiting
loss of consciousness

38
Q

how do you treat N2O overdose

A

decrease N2O concentration by 5-10%
reassure
do not remove nosepiece

39
Q

if you remove a nosepiece from someone who is oversedated with IHS what can happen

A

diffusion hypoxia

40
Q

how do you deal with a patient who panics from IHS

A

reassure
if they cannot cope then abort

Sedation Symposium (9 decks)

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