Principles of Conscious IV sedation and Nitrous Oxide sedation

Question 1

What are the 3 most important things in conscious IV sedaation?

Answer 1

Pt comfort
O2
Keep pt alive

Question 2

What do drugs do that are used for Iv sedation? Bring pt up or down?

Answer 2

Down

Question 3

Hwo should sedation be administered?

Answer 3

Titrate not oversedate and use reversal agents

Question 4

Does every sedation drug have a reversal agent?

Answer 4

No

Question 5

• Only inorganic anesthetic gas in clinical use
• Colorless and odorless
• Capable of oxygen supporting combustion
• Effect on organ systems
• Cardiovascular
• Stimulation of catecholamine yet myocardial depression
• Respiratory
• Stimulation of catecholamine
• Tachypnea and decrease tidal volume
• Renal
• Reduce urine output
• Toxicity
• Prolong exposure Bone marrow depression, Neurological deficiencies peripheral
  neuropathies and pernicious anemia

Answer 5

N2O

Question 6

What are the 3 things we are worried about in case of NItrous Toxicity?

Answer 6

Pernicious anemia, Bone marrow suppression, and neurological deficiencies

Question 7

DOes N2O break apart in the body?

Answer 7

No stays together

Question 8

The higher the concentration of the gas inhaled, the
quicker or slower arterial tension of the gas increases?

Answer 8

More rapidly ( Start Nitrous slowly)

Question 9

• The higher the concentration of the gas inhaled, the
  more rapidly arterial tension of the gas increases
• Fresh gas will be pushed into the lunch from the anesthesia machine
   increase arterial N 2 O arterial tension
• So its important to start the Nitrous slowly and not blast it high in the
  beginning

Answer 9

Concentration Effect

Question 10

• Occurs when a second inhalation anesthetic is
  administered along with N 2O-O 2
• Extreme update of N 2O will form a vacuum at alveoli
  that forces other air ( in this case, other inhalational
  agent) into the lungs

Answer 10

• 2nd Gas Effect

Question 11

If patient simply breath room air and not O2  Patient may get ________

Answer 11

diffusion hypoxia

Question 12

• As the N2O is rushed out of the body, it will take other airs out including CO2
• Lowering CO 2 tension in blood will cause respiratory depression
• S/S
• Headache, Nausea, Lethargy  hangover effect
• Prevention: administer 100% O2 for 3-5 mins at the termination of the procedure

Answer 12

• Diffusion Hypoxia

Question 13

Is O2 tank green or blue?

Answer 13

Green

Question 14

Is NO2 tank green or blue?

Answer 14

Blue

Question 15

Is N2O metabolized in the body?

Answer 15

No

Question 16

____% N2O is equivalent to 10-15mg of morphine

Answer 16

20%

Question 17

The following are ___ for N2O
* Claustrophobic patients
* Compulsive personality ( take charge)
* Children with severe behavior problems
* Upper respiratory tract infection
* COPD ( chronic bronchitis, Emphysema)
* Pregnancy

Answer 17

Contraindications

Question 18

What is the ideal starting flow rate of O2 for adult pt?

Answer 18

6L O2

Question 19

What is the ideal starting flow rate of O2 for peds pt?

Answer 19

3-5L O2

Question 20

What is the maximum N2O conc you can give to pt?

Answer 20

70% N2O: 30% O2

Question 21

Reservoir bag is _________*
* Minute volume of gas is inadequate
* Large leak at the nasal hood
* Vacuum on the scavenging system is too high

Answer 21

Totally Deflated

Question 22

Reservoir bag is _________

• Minute volume of gas is too great
• Hose obstruction

Answer 22

• Overly Inflated