IV sedation

Question 1

main aim of IV sedation

Answer 1

anxiolysis

Question 2

GABA

Answer 2

most common inhibitory neurotransmitter in the CNS
lessens ability for nerve cells to recieve, create or send chemical messages to other nerve cells
does this by prolonging time for receptor polarisation

Question 3

glycine

Answer 3

inhibitory neurotransmitter acting in brain and spinal cord

Question 4

cardiovascular effects of benzodiazepines on the body

Answer 4

decreased BP by muscle relaxation causing decreased TPR
increased HR due to baroreceptor reflex compensating for BP fall

Question 5

respiratory effects of benzodiazepines on the body

Answer 5

CNS depressant and muscle relaxant
decreased cerebral response to CO2 the primary driver of breathing

Question 6

name 3 side effects that may be experienced with benzodiazepines

Answer 6

amnesia
drowsiness
unsteadiness

Question 7

name 2 drugs benzodiazepines may interact with

Answer 7

antihistamines
antipsychotics
antidepressants

Question 8

why is diazepam painful upon injection

Answer 8

insoluble in water so prepared with propylene glycol whihc is painful upon injection

Question 9

why is midazolam preferred to diazepam

Answer 9

painless to inject
faster onset
quicker recovery time

Question 10

why should canula remain in place throughout treatment

Answer 10

in case emergency drug is required

Question 11

why should butterfly cannulas be avoided

Answer 11

made of metal which increases risk of clotting, they are also easily dislodged

Question 12

what material should a cannula ideally be made from to minimise risk of blockage

Answer 12

teflon

Question 13

how many staff members must be present at a practice to carry out sedation

Answer 13

minimum of 3
2 sedation trained who must be with patient at all times throughout treatment
1 other for runner and emergencies

Question 14

what monitoring of the patient should be done throughout the duration of treatment

Answer 14

pulse oximeter
blood pressure

Question 15

signs that adequate IV sedation has been reached

Answer 15

slurring and slowing of speech,
relaxed,
delayed response to commands,
willingness to accept treatment,
eves sign (loss of motor control)

Question 16

Eves sign

Answer 16

loss of motor control
ask patient to close eyes and put arms out to side then touch nose - sedated patient will miss

Question 17

working time of midazolam

Answer 17

roughly 45 mins

Question 18

how long should a patient be kept for after the last increment of midazolam has been given

Answer 18

at least 60 minutes after last increment of drug given

Question 19

what should be done if someone experiences respiratory depression

Answer 19

stop procedure
talk and shake patient
head tilt, chin lift, jaw thrust to open airway
check if chest rising and falling
if O2 sats dont improve nasal cannula with O2 2l/ min
still no improvement then hudson mask 5l/min
if no improvement flumazenil reversible agent

Question 20

what dose does flumazenil come in

Answer 20

500mcg per 5ml

Question 21

what doses should flumazenil be given in

Answer 21

200mcg initial dose then 100mcg increments every 60s until response seen

Question 22

why is there a potential risk of re sedation by midazolam even after flumazenil given

Answer 22

flumazenil has a shorter half life than midazolam

Question 23

can midazolam cross the blood brain barrier

Answer 23

yes midazolam becomes lipid soluble at physiologic pH so able to cross BBB

Question 24

where is midazolam metabolised

Answer 24

mainly liver but some extra hepatic metabolism in bowel

Question 25

if cannulating in dorsum of hand, name 3 veins that could be cannulated

Answer 25

cephalic
basilic
metacarpal
dorsal venous arch

Question 26

dose incremements of midazolam

Answer 26

2mg initial bolus and assess after 1 min
then 1mg increments every 60s until desired effect achieved
(very rarely go above 7.5mg)

Question 27

name 3 things that may impact the therapeutic dose of midazolam required

Answer 27

stress
drugs
alcohol
sleep