IVS Flashcards
(36 cards)
What are the indications for IVS
Anxiety
Health conditions
Neuromuscular conditions
What are the contraindications for IVS
Severe respiratory disease
Severe cardiovascular disease
Pregnancy (not 100%)
Unpredictable metabolism
Personality disorders
Poor veins
Why is severe respiratory & cardiovascular disease a contraindication for IVS
Midazolam is a respiratory depressant so anyone who has a decreased respiratory function could become deoxygenated when taking midazolam or it could cause cardiovascular depression.
Why is IV sedation contraindicated in pregnancy
Damage to foetus this can be done in 2nd trimester it’s a last resort but has less risks than GA. Pt must express before op as to not sedate baby after op if breastfeeding
Why is IV sedation contraindicated in children
Unpredictable outcomes, opposite effect as desired and unpredictable outcomes.
Why is unpredictable metabolism contraindicated in IV sedation
Hepatic or renal impairment changes drug metabolism and profanity/duration of action. Tolerance will increase dose required for desired effect
What is the half life of midazolam
1.9h + - 0.9h
What is the max dose of midazolam and in what concentration do you get it
17.5mg
1mg/1ml
What should be done in a pre assessment for IVS
General assessment
Medical assessment
Dental assessment
Decision and treatment plan
Give written pre and post op instructions
What are the ASA (American Society for Anaesthesiology) classification
1 normal pt
2 mild/well controlled systemic disease
3 sever systemic disease
4 severe systemic disease with constant threat to life (unstable angina)
5 moribund patient needing operation to survive
6 brain dead having organs taken for donor purposes
When should pre op be done
At a different appointment to operation unless it’s and emergency
What should be done just before operation
Check general obs
Check MH
Check consent
Check carer
What is checked in general obs
General appearance
HR
BP
RR
O2
What are the benefits of IVS
Outpatient procedure
Cheaper
Safer than GA
effective
Disadvantages to IVS
Retrograde amnesia
Unpredictable in youngsters
Patients may need sedation for all treatments
Think they were asleep last time making second time hard
Increased medical complications
Oral access compromised
What are the stages on operation day
Pre assess
Pre op checks
Pre op prep (drugs and stuff)
IV access
Sedation
Clinical procedure
Recovery
Monitoring is carried out from when drug is administered
What is a timer used for in IVS
Time from when drug was administered
When can cannula be removed
60 minutes after last midazolam dose
What happens to vitals after midazolam administration
Shallower slower breaths
Reduced heart rate
What do you expect vitals to be on day of procedure
Elivated HR & BP
What should be done if pt is diabetic
Take blood glucose p, this should be above 4 and if it is not the sugary food should be given and this should be retaken above 4 before procedure starts
What are the two different sites of cannulation called
Anti-cubital fossa
Dorsum of hand
Benefits & disadvantages of anti-cubital fossa
Larger fixed vein less susceptible to climatic vasodilation
Less visible, brachial artery & median nerve very close
Benefits & disadvantages cannulating dorsum of hand
More visible, no delicate surrounding structures, more obvious if in wrong place
Vaisoconstrict if cold
Smaller veins and more painful
