IV Sedation II Flashcards
(28 cards)
Purpose of sedation?
Control of fear/ anxiety
Reduce stress
Control gag reflex
Tx of un-co-operative pt
Advantages of IV sedation?
Remote from operating site Rapid onset Pt co-op less important Amnesia Mouth breathing not important
Disadv of IV sedation?
Analgesia not clinically useful
Overdose - resp depression
Disinhibition effects
Sexual fantasy
Pathway of pt management in anxiety?
Time/ TLC –> psychotherapy –> hypnosis/ acupuncture –> IHS –> oral sedation –> IV sedation
Social issues w/ providing IV?
Need responsible escort
Following post-op instructions
Time off work/ child care
What is ASA?
American society of anaesthesiologists physical status rating
What are 5 ASA ratings?
I = normal healthy pt II = mild to moderate systemic disease III = severe systemic disease, not incapacitating IV = severe systemic disease, threat to life V = moribund pt not expected live 24 hr w/o intervention
Which ASA scale would be contraindication dental tx?
IV/ V
Why key to obtain consent prior sedation?
Can’t consent when sedated
What to do if pt unable consent?
Talk next of kin/ discuss w/ care staff
2 professionals independently agree tx in pt best interest
Appoint independent mental health capacity advocator
What is included in baseline physical exam prior IV?
Pulse Respiration levels Oxygen sats Blood pressure Weight/ BMI
What are the 6 effects of benzodiazepine
SAD AAH
Sedation
Anxiolytic
Decrease skeletal muscle tone
Amnesia
Anticonvulsant
Hyponosis
Contraindications IV sedation?
Allergy benzodiazepine Poor veins Sleep apnoea Pregnancy High BMI Hepatic impairment Extreme of age ASA III,IV,V Pulmonary insufficiency
Main issues with drug interactions and sedatives?
If drug has sedative effect as well - prolonged and profound sedation
Drug increases respiratory depression
If metabolism of midazolam is inhibited
Example of drugs contraindicated with midazolam
Clarithromycin
Erythromycin
Fluconazole/ ketoconazole
…mycin (macrolides)
…azole (triazoles)
…navir (protease inhibitors)
What common medications can have enhancive effect on midazolam?
Anti-histamines
Anti-psychotics
Beta-blockers
How manage pt on medication prior IV?
Check BNF
What to set up before pt arrive for sedation?
Midazolam - check date/ batch Saline Straight filter needle draw drug Pre injection swab Tagaderm Cannula - 22G Ampoule opened Tourniquet
What emergency equipment should be available?
Oxygen (emergency oxygen) - 15L/min
Suction and non-mains powered suction
Emergency drugs inc flumazenil
What temp is considered normal when monitoring pt?
36-37.5
What expect pulse rate of be?
70 bpm
What expect respiration rate to be?
12-20
What expect BP to be?
120/80
What check when monitoring pt when sedated?
Colour - check cyanosis
Pulse
Respiration rate
Temp
