Conscious Sedation Flashcards
(28 cards)
What is the intent of procedural sedation and analgesia?
Depressed level of consciousness that allows patient to maintain oxygenation and airway control independently
Goals of conscious sedation
- Minimize pain
- Alleviate anxiety
- Maximize amnesia
- Control behavior
- Maintain CV and resp status
Define anxiolysis
- Minimal sedation
- Response to verbal stimulation is normal
- Cognitive function and coordination may be impaired
- CV and resp functions unaffected
What drug is MC used for procedural sedation and analgesia?
Versed (Midazolam)
What is the reversal agent of Versed (Midazolam)?
Flumazenil
Cons of Versed (Midazolam)
- No analgesia
- Resp depression
- Hypotension w/high doses
- Disinhibition
What drug is MC used for mild-mod sedation?
Lorazepam (duration of action is longer than Midazolam)
Define moderate (conscious) sedation
- Drug induced depression of consciousness
- Pt responds purposefully to verbal commands
- Airway is patent, spontaneous ventilation adequate
- CV function usually unaffected
Define deep sedation
- Pt responds purposely following repeated/painful stimulation
- Independent maintenance of vent function may be impaired
- Spontaneous ventilation may be inadequate
- CV function usually maintained
Define general anesthesia
- Drug induced loss of consciousness
- Pt cannot be aroused
- Ventilatory function is impaired
- CV function may be impaired
Risks of sedation
- Hypotension
- Hypoxia
- Bradycardia
- Cardiac dysrhythmias
- Respiratory depression
Pros of Versed (Midazolam)
- Decent amnesia
- Has a reversal agent
How does lorazepam compare to midazolam for sedation?
- Onset is slower than midazolam
- Duration is LONGER (6-8 hrs vs. 30-60 mins)
- Double the potency of midazolam
Pros of Ketamine
- Analgesia/amnesia
- Airway reflexes maintained
- No pain perception
- Dosing IM, IV, PO, PR
Cons of Ketamine
- Sympathomimetic
- Increased ICP, IOP and BP
- Laryngospasm
- Emesis
- Emergence reaction
- Increases muscle tone
- Patient will still move
Describe Etomidate
- Ultra short acting non-barbiturate hypnotic used for anesthesia
- Works via GABA receptors
- Produces rapid induction without histamine release and w/minimal CV/respiratory effects
Pros of Etomidate
- Quick on and off
- No histamine release
- Minimal CV/resp effects
- Possible amnesia
Cons of Etomidate
- Myoclonus
- NV
- No analgesia
- 12-48 hrs inhibition of adrenal axis
Describe Propofol
- Potent ultra short acting sedation and anesthesia
- MOA unknown (GABA?)
- NO analgesic properties
What are the ultra short acting drug options for sedation?
- Etomidate
- Propofol
Pros of Propofol
- Quick on and off
- Antiemetic
- Amnesia
- Anticonvulsant
- Decreases ICP and IOP
Cons of Propofol
- Burns during injectino
- No analgesia
- Hypotension
- Decreased resp drive
- Allergic reaction to soy and eggs possible
Role of opiates in procedures?
Provides analgesia and sedation
What is the usual opiate of choice in procedures/sedation?
Fentanyl (prompt onset and short duration w/minimal CV/resp effects)
