M7 Intravenous sedation

Question 1

Who produced the report ‘A Conscious Decision’ (2000)

Answer 1

Department of Health

Question 2

What does ASA stand for?

Answer 2

American Society of Anaesthesiologists

Question 3

The American Society of Anaesthesiologists divided the effects of sedation into 3 categories. What are they?

Answer 3

Minimal, moderate and deep.

Question 4

What is pharmacodynamics?

Answer 4

The effects the drug has on the patient, including side effects

Question 5

What is pharmacokinetics?

Answer 5

The way the drug is absorbed into the body, distributed around it and subsequently eliminated.

Question 6

How many schedules are within the Misuse of Drugs Act 1971?

Answer 6

5

Question 7

How many benzodiazepine drugs are currently being used as sedatives?

Answer 7

35

Question 8

When was midazolam first produced?

Answer 8

1970’s

Question 9

What classification of drug does midazolam fall into?

Answer 9

Class C, schedule 3

Question 10

How long should you keep invoices for midazolam?

Answer 10

2 years

Question 11

Each ampule of midazolam is stamped with what?

Answer 11

Name, Concentration, expiry date, batch number

Question 12

What concentration does midazolam come in?

Answer 12

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

Question 13

What is the recommended ampoule concentration for dental practices?

Answer 13

5mg in 5ml

Question 14

What are 3 side effects of midazolam?

Answer 14

Cardiovascular effects
respiratory effects
coughing
headaches
drowsiness
nausea and vomiting
loss of inhibition
irritation at cannula site
restlessness

Question 15

Why is midazolam not recommended for pregnant patients?

Answer 15

Midazolam is known to cross the placenta barrier and enter the foetus blood. If in the 3rd trimester the baby may experience benzodiazepine withdrawal syndrome.

Question 16

Why is midazolam not recommended for children?

Answer 16

May exhibit a paradoxical effect (agitation, hyperactivity)

Question 17

If a patient experiences an allergy to midazolam, what drug must not be give and why?

Answer 17

Flumazenil. It will increase the anaphylactic reaction

Question 18

Using 2 intravenous drugs together is know as….

Answer 18

Polypharmacy

Question 19

What are the effects of erythromycin on midazolam?

Answer 19

Inhibits the metabolism of midazolam resulting in a prolonged effect.

Question 20

What are the effects of St Johns Wort on midazolam?

Answer 20

Enhances the metabolism of midazolam resulting in a reduced effect

Question 21

How many groups are within the ASA classification system?

Answer 21

6

Question 22

What is the usual dose of midazolam for an ASA class 1 patient?

Answer 22

Between 2.5mls - 7.5mls

Question 23

What is the initial dose of midazolam for an ASA 1 patient?

Answer 23

2mg over 30 seconds. Monitored for 2 mins. further 0.5 - 1mg until sedation achieved.

Question 24

What is the initial dose of midazolam for elderly patients?

Answer 24

1 - 1.5mg over 2 mins.

Question 25

In an elderly patient, what should the total of midazolam not exceed?

Answer 25

3.5mg

Question 26

How long is midazolam half life?

Answer 26

Approximately 1 - 4 hours

Question 27

What 2 stages form the half life of benzodiazepines?

Answer 27

Alpha Beta

Question 28

What does the benzodiazepine Alpha half life do?

Answer 28

Distribution and redistribution. Drug is introduced into the body, taken to the brain then redistributed to other parts of the body.

Question 29

How long is the benzodiazepine Alpha hale life?

Answer 29

4 - 18 minutes

Question 30

What does the benzodiazepine Beta half life do?

Answer 30

Metabolism and excertion. The body breaks down the drug and eliminates it.

Question 31

How long is the benzodiazepines Beta half life?

Answer 31

1 - 4 hours. Can be longer in adolescents and the elderly

Question 32

For an ASA 1 patient, approximately 5mg of midazolam will be eliminated from the body within how many hours?

Answer 32

5 hours

Question 33

Midazolamis thought to go through how many phases of sedation?

Answer 33

4 phases

Question 34

What is eve sign negative?

Answer 34

The patient is able to touch their nose

Question 35

What is eve sign positive?

Answer 35

The patient is not able to touch their nose

Question 36

How quickly will a patient reach stage IV of sedation?

Answer 36

Approximately 1 hour

Question 37

What is stage 1 of sedation?

Answer 37

Midazolam is within the blood at the brain, it's also at its maximum. Patient will have slurred speech, unaware of their surroundings and co-ordination will be impaired and can experience amnesia.

Question 38

What is stage 2 of sedation?

Answer 38

Midazolam gets redistributed to other body tissues which decrease the effects of sedation. Patients become more aware and the amnesic effects decreases. Alpha half life.

Question 39

What is stage 3 of sedation?

Answer 39

Patient will start to feel more normal but anxiolytic effect still present

Question 40

What is stage 4 of sedation?

Answer 40

Patient will have appeared to have recovered but only Alpha half life has occurred.

Question 41

What are the signs and symptoms of midazolam overdose?

Answer 41

Signs: chin dropping, lack of response to verbal requests Symptoms: drowsiness, mental confusion, hypotension, cardiorespiratory depression, muscle relaxation

Question 42

What would you give if a patient is over sedated?

Answer 42

Flumazenil

Question 43

What is the maximum dose of flunazemil a patient can be given?

Answer 43

1mg

Question 44

What is the concentration of Flunazemil?

Answer 44

500mg in 5ml

Question 45

What is the usual dose of flunazemil?

Answer 45

300 - 600mcg

Question 46

How is flunazemil titrated?

Answer 46

200mcg over 15 seconds. if needed a further 100mcg every minute

Question 47

How long is flunazemil half life?

Answer 47

Approximately 50 minutes

Question 48

What are the effects of flunazemil?

Answer 48

Anxiety, disorientation, headaches, aggressiveness and agitation

Question 49

What is the concentration Propofol comes in?

Answer 49

200mg in 20mls

Question 50

What is Propofol half life?

Answer 50

2 - 24 minutes

Question 51

What is the recovery for propofol?

Answer 51

5 minutes

Question 52

How is propofol given?

Answer 52

Patient controlled electronic pump

Question 53

What are the benefits of using propofol?

Answer 53

Provides patient with amnesic and hypnotic effects and reduces risk of vomiting

Question 54

Who would you not use propofol on?

Answer 54

Pregnant patients. Drug is known to cross the placenta barrier. Patients with egg allergies. Drug is an emulsion which is dissolved in purified egg

Question 55

What must be available when using propofol?

Answer 55

Airway management, supplemental oxygen, artificial ventilation, cardiovascular resuscitation, highly trained staff