5. It releases patient’s
feelings
Sedation effects differ from person to person.
The most common feelings are drowsiness and
relaxation. Once the sedative takes effect,
negative emotions, stress, or anxiety may also
gradually disappear.
9. Indications for the use of sedative
drugs
Premedication
'Sedo-analgesia'. This term describes the use of a combination
of a sedative drug with local anaesthesia
Radiological procedures. Some patients, particularly children
and anxious individuals, are unable to tolerate long and uncomfortable
imaging procedures without sedation
Endoscopy.
Intensive therapy. Most patients require sedation to facilitate
mechanical ventilation and other therapeutic interventions
Supplementation of general anaesthesia
11. Minimal Sedation
Does not mandate implementation of Conscious
Sedation Policy
Patient maintains
– Normal respiration
– Normal eye movement
– Normal response to command, and
– Normal or baseline mental orientation
12. Moderate Sedation
Protective reflexes are intact
• Airway remains patent
• Spontaneous ventilation is adequate
• Patient responds to physical stimulation or
verbal command
• No adverse effect on cardiorespiratory function
13. Deep Sedation
Use of medication to induce a level of depressed
consciousness from which the patient is not easily
aroused
• Can result in partial or complete loss of
protective airway reflexes
• Need for airway support
• Beyond the scope of this policy
14.
15. Airway Assessment
• Mallampati class
• Difficult airway anatomy
• History of difficult intubation
• Disease states associated with a difficult
airway
17. Difficult Airway Anatomy
• Short/fat neck
• Decreased mobility of the airway joints
• Dental overbite or small mandible
• Large tongue
• Distortion in the airway (extrinsic or intrinsic)
Difficult anatomy may make mask/bag ventilation
difficult or impossible
20. What drugs are used?
The drugs used in conscious sedation vary based on delivery method:
Oral: You’ll swallow a tablet containing a drug like diazepam (Valium) or
triazolam (Halcion).
Intramuscular: You’ll get a shot of benzodiazepine, such as midazolam
(Versed), into a muscle, most likely in your upper arm or your butt.
Intravenous: You’ll receive a line in an arm vein containing a
benzodiazepine, such as midazolam (Versed) or Propofol (Diprivan).
Inhalation: You’ll wear a facial mask to breathe in nitrous oxide.
21.
22.
23.
24. Drugs used for Sedation
Benzodiazepines
• Produce amnesia, sedation, anxiolysis
• Anticonvulsants
• Minimal effects on circulation
• Diazepam (Valium) – T1/2 is 25 – 30 hours
• Lorazepam (Ativan) – T1/2 is 10 – 20 hours
• Midazolam (Versed) – T1/2 is 1 – 4 hours
25. Midazolam administration
A suitable administration regimen is 2mg injected over 30
seconds, followed by a pause for 90 seconds before giving further
increments of 1mg every 30 seconds until sedation is judged to be
adequate.
The correct dose has been given when there is slurring of speech
and/or a slowed response to commands, and the patient exhibits a
relaxed behavior.
26. Propofol (Diprivan) is a potent, short-acting intravenous
anaesthetic agent.
it is a reliable and safe drug for intravenous sedation.
In comparison with midazolam, recovery appears to
be rapid and ‘clear-headed’, but amnesia is often less
profound.
It is particularly useful for short (5–10 minute) cases
very short distribution half-life (2–4 minutes) and an
elimination half-life of 30–60 minutes.
Intravenous propofol by infusion
27. Administration
Diprivan 1% is presented in 20ml glass ampoules containing
200mg of propofol emulsion (10mg/ml).
A dose of 30mg (3ml) of propofol is given slowly, followed
immediately by an infusion at an (initial) rate of 300mg (30ml)
per hour.
Propofol sedation should be used only by those trained in anaesthesia
28. • Drugs that bind to opioid receptors and produce
– Analgesia
– desired effect
– Euphoria
– clinically useful but potentially dangerous
– Respiratory depression
– depresses medullary ventilation centers.
– Other side effects: Nausea, pruritis, orthostatic hypotension.
Opioids
29. Opioids : Some I.V. Dosing Guidelines
• Morphine : 0.025 – 0.05 mg/kg, max of 0.1
mg / kg – 70 kg patient : 1.75 – 3.5 mg, Max of
7 mg
• pethidine 0.5 – 1.0 mg / kg, max of 50 – 100
mg
• Fentanyl : 1 – 2 mcg / kg, max of 3 mcg / kg
Opioids
30. • Benzodiapines (i.e. Midazolam) and narcotics
(i.e. fentanyl) together with have a synergistic
effect on sedation and respiratory depression.
Use extreme caution when using these two
drug families together !!!!!
Opioids with Benzodiazepines
31. Moderate Sedation Risks
• Respiratory depression
• Loss of airway
• Vomiting/aspiration
• Arrhythmias
40. Reverse of Benzodiazepines
Flumazenil
• A benzodiazepine receptor antagonist
• Treat overdoses of benzodiazepines with 0.2
mg IV per minute (maximum single dose is 1 mg)
• Rapid reversal with large boluses may result in
arrhythmias, hypertension, aggitation or seizures
41. Reverse of opioids
Naloxone
• A pure narcotic agonist that reverses the respiratory depression
caused by narcotics
• Reverses respiratory depression AND analgesic effects of opioids
• Rapid reversal with a large bolus is undesirable
• Titrate 0.05 mg – 0.1 mg to effect
• Half-life about 30 min
• Pulmonary edema, narcotic withdrawal symptoms, and pain
crisis (if on chronic opioids) are possible
42. Equipment needed
• Pulse oximeter
• Oxygen source
• Ambu-bag with mask and oral airway
• Laryngoscopes with Miller and Mac blades
• Endotracheal tubes with stylet
• Functioning suction with Yankauer tip
• ECG monitor
45. Intra-procedure
Patient should be responsive to physical and
verbal stimuli at all times
• If unresponsive, patient has become deeply
sedated
• Stop procedure
• Initiate appropriate airway management
• Defer further administration of sedatives
until patient returns to moderate sedation