IV sedation

Question 1

Indications for IV sedation..

Answer 1

Psychological
Difficult tx
MH
Gag reflex
To avoid GA

Question 2

Contraindications for IV sedation..

Answer 2

Allergy
Children
Extensive tx
Needle phobia
No escort
IV drug user
Pregnancy
Liver or renal disease
Obese BMI over 35

Question 3

Iv sedation advantages…

Answer 3

Rapid onset
Controllable - titrated
Anxiolytic
Amnesic
IV access - for emergency drugs

Question 4

Iv sedation disadvantages…

Answer 4

Gaining IV access
Time consuming
Needle phobic

Question 5

What are the 4 intravenous agents?

Answer 5

Diazepam
Midzolam
Propofol
Fentanyl

Question 6

How can diazepam be given?

Answer 6

Orally, IM or IV

Question 7

What is the half life of diazepam?

Answer 7

43 hours

Question 8

How long can recovery take with diazepam?

Answer 8

72 hours

Question 9

What family does Midazolam belong to?

Answer 9

Benzodiazepine

Question 10

Midazolam has a…

Answer 10

Rapid onset

Question 11

What is the short half life of midazolam?

Answer 11

1.9hrs

Question 12

What does midzolam do?

Answer 12

Muscle relaxant, anticonvulsant, amnesia, analgesia

Question 13

How long does it take for midazolam to travel from the arm to the brain?

Answer 13

35 seconds

Question 14

How is midazolam redistributed?

Answer 14

Muscle and fatty tissue

Question 15

How is midazolam eliminated?

Answer 15

liver and excreted by kidney

Question 16

What is Flumazenil?

Answer 16

Midazolam reversal

Question 17

What is the brand name of flumazenil?

Answer 17

Anexate

Question 18

What is the half life of Flumazenil?

Answer 18

50 mins

Question 19

What airway assessment will be completed for IV sedation?

Answer 19

Mallampati classification

Question 20

What is a common benzodiazepine pre-medication?

Answer 20

Temazepam 5mg
x2 tabls one night before and one 1hr before app
Escort required

Question 21

Pre op instructions for IV sedation?

Answer 21

No food/drink 2 hrs before - light meal
Escort
Appropriate travel
No alcohol 24hrs before
Medication take as normal
Bring inhalers / GTN spray
Nail varnish removed

Question 22

Post op instructions for IV sedation?

Answer 22

No alcohol for 24 hrs
No driving/ operating machinery
Not to be left alone
No important decisions
Avoid social media

Question 23

What would happen if the treatment changed during IV sedation?

Answer 23

Treatment cannot be consented to, so pt will have to be brought back to discuss options

Question 24

What size is the green IV cannula?

Answer 24

18G

Question 25

What size is the pink IV cannula?

Answer 25

20G

Question 26

What size is the blue IV cannula?

Answer 26

22G

Question 27

What size is the yellow IV cannula?

Answer 27

24G

Question 28

Which is the flow rate of the yellow IV cannula?

Answer 28

20 ml/min

Question 29

Which is the flow rate of the blue IV cannula?

Answer 29

33ml/min

Question 30

How should Iv drugs be administered?

Answer 30

Titrated

Question 31

what does bolus mean?

Answer 31

Rapid administration

Question 32

How should IV midazolam be administered ?

Answer 32

1mg bolus over 30sec wait 1 min

Question 33

Common areas for cannulation?

Answer 33

Dorsum - hand Antecubital fossa - infront of elbow

Question 34

Benzodiazepines are

Answer 34

Sedation, muscle relaxants, and anterograde amnesia

Question 35

What other name is midazolam known by?

Answer 35

Hypnovel

Question 36

What year was midazolam available in the UK?

Answer 36

1983

Question 37

what schedule of controlled drug is midazolam classified as?

Answer 37

schedule III controlled drug

Question 38

midazolam is available in what presentations

Answer 38

10mg in 5ml 10mg in 2ml 5mg in 5ml

Question 39

What does the blue dot on the ampoule represent?

Answer 39

Signifies the place to hold to get ease for opening

Question 40

What is the PH of midazolam?

Answer 40

3.4

Question 41

If a patient had an allergic reaction to midazolam, how would the reaction be managed

Answer 41

adrenaline IV - 0.5ML 1:10000 IM - O.5ML 1:1000

Question 42

What does Anxiolytic mean?

Answer 42

Reduces anxiety

Question 43

Midazolam binds to which receptors in the CNS?

Answer 43

Benzodiazepine receptors

Question 44

Benzodiazepine receptors run parallel to which other receptors?

Answer 44

Gamma-aminobutyric acid (GABA)

Question 45

Benzodiazepine enhances the effect of neurotransmitters on the GABA receptors leading the brain to do what?

Answer 45

Decreased brain activity

Question 46

What is half-life?

Answer 46

The time it takes for plasma levels of the drug to drop in half

Question 47

Name the two stages that form the Benzodiazepines half-life?

Answer 47

Alpha & Beta

Question 48

What does the Alpha half-life do?

Answer 48

Distribution and redistribution - travels to the brain and then from the brain to other tissues in the body.

Question 49

How long is the Alpha half-life?

Answer 49

4-18 minutes

Question 50

What does the Beta half-life do?

Answer 50

Metabolism & Excretion (the body breaks down so it is no longer active, then removed from the body)

Question 51

How long is the Beta half-life?

Answer 51

1-4 hours (can be longer for elderly/teens)