Flashcards in IV sedation Lecture #2 Deck (70):
What types of sedation are considered conscious sedation?
Can the patient control their own airways under conscious sedation?
If a person is in deep sedation can they control their own airways?
-Possibly but maybe not
If a person is in general anesthesia what do you need to do for the respiratory system?
-Intubation of patient
Does oral sedation have the ability to go beyond minimal or moderate sedation to deep or general?
What is minimal sedation?
-Independent airway/respond normally
What is moderate sedation?
-Responds to verbal commands, respiratory and CVD unaffected
What are some common Benzodiazepines used for IV sedation?
What are opioids used for IV sedation?
What are advantages of Oral sedation?
-Ease of administration
Where does oral sedation absorption occur?
T/F No specialized training is required beyond the doctoral level for oral sedation
What are the disadvantages of oral sedation?
-Slow onset of action
-Titration of dose unclear
-Prolonged duration of effect
-Difficulty of administering reversal agents
-Meals and drug interaction
What are antihistamines/Barbiturates are used for oral sedation?
What effects do Benzodiazepines (not analgesic) have?
-Skeletal muscle relaxant
What do Benzodiazepines target mostly?
-CNS GABA A receptors which are direct and fast acting
T/F Benzodiazepine is analgesic
What is the onset of Diazepam (Valium)?
What is the half life of Valium?
What dose of Valium do you give?
-5-15 mg 1 hour prior to appt
Is Valium long acting?
What are the side effects of Valium?
Do you ever want to give Triazolam to a pregnant patient?
-No because it is an Category X drug
What is another name for Triazolam?
What is the onset of Triazolam (Halcion)?
What is the half life of Triazolam (Halcion)?
What dose do you give for Triazolam (halcion)?
-.25 mg the night before and .25 to .5 mg 1 hr prior to appt.
What are the side effects of Triazolam?
What is the other name for Midazolam?
What is the onset for Midazolam (Versed)?
-30-60 minutes up to 2 hours
What is the half life of Midazolam (Versed)?
-1.5 - 2.5 hours
What is the dose of Midazolam (versed)?
-1-2 mg titration (usually given IV but some liquid versed is being used)
What are the side effects of Versed (Midazolam)?
(potentiates the respiratory depression of phentenyl)
What is the other name for Flumazenil?
What is Flumazenil (Romazicon)?
-A reversal agent
T/F The half life of the reversal agent is shorter than the half life of the drug you have given
What doses of Flumazenil (Romazicon) do you use?
-.2 mg to a maximum dose of 3 mg
What is the onset of Flumazenil (Romazicon)?
What are the complication/contraindication of Benzodiazepine?
-Birth defects (Cleft lip/Cleft Palate)
Why is valium a contraindication of Benzodiazepine?
-Extravasation into tissues
Where is Diazepam metabolized?
T/F Clonazepam has a slower onset of action.
What is Clonazepam used for?
-Adjunct for anxiolytic and sedative peoperties
Is Diazepam soluble in water?
What sedative drug is more potent than Diazepam or Clonazepam?
What might Midazolam (Versed) do to respirations when used with narcotics?
Is Midazolam solube in water?
What are the advantages of Nitrous oxide?
-ease of use
-Rapid onset of action
-Ability to titrate effect
-Analgesic and sedative properties
-Few drug-drug interactions
-No escort/restriction of activities
What are the disadvantages of Nitrous oxide?
-Decreased efficacy for severely anxious pt
-Chronic exposure to staff
T/F In all oral sedation the pt needs an escort,
What are the contraindications of Nitrous oxide?
-Sever blockage of nasal passages
-Sever blocked Eustachian tube
What is the deepest plane of anesthesia that you should allow nitrous to go to?
30-40% of nitrous oxide is analgesic and is compared to what amount of what other drug?
What are the predominant effect of opioids?
-Depression of sensorium and respirations
What are opioids used for oral sedation?
What do opioids do to the vasculature?
-Vasodilation leading to hypotension and increased CO
What side effects do opioids have?
-Chest wall rigidity
What does of Fentanyl do you give?
-30 to 50 micrograms 10-15 minutes by IV
T/F Fentanyl and Versed potentiate respiratory depression.
When are using Fentanyl and Versed together which do you administer first?
-Fentanyl then Versed
What do opioids have to do with histamine?
-Can cause histamine release that could lead to anaphylactic shock
What is Naloxone (Narcan)?
-A pure antagonist that reverses analgesia and respiratory depression
What is the duration of Naloxone?
What dose do you give of Naloxone?
-.1-.2 mg with a max of 10 mg
What is Propofol?
What type of analgesic properties does Propofol have?
What do you use Propofol for in anesthesia?
What dose of Propofol do you use?
-.5 mg - 1 mg/kg dosing
Who is propofol contraindicated for?
-Pts allergic to egg and soy