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51 Cards in this Set

  • Front
  • Back
What is conscious sedation done FOR?
Painful procedures
How do we classify painful procedures?
-Mildly invasive
-Mod-Severely invasive
What are some examples of Mildly invasive procedures?
-Finger sticks
-Venipuncture
-IV cannulation
-Reservoir access
What are some examples of moderate to severely invasive procedures for which we do consious sedation?
-Lumbar punctures
-BM aspirates/biopsies
-Place/remove Chest tube
What is the RANGE of sedation that can be achieved?
-Baseline
-Local anesthesia
-Mild, mod, deep sedation
What are the main points to remember about Minimal sedation?
-Normal verbal command response
-May impair cognition/coordin.
-NO CV/ventilatory changes
What are the main points to remember about Moderate sedation?
-PURPOSEFUL verbal response, may need lite tactile stimulus
-Spontan. ventilation adequete
-CV function usu. maintained
What are the main points to remember about DEEP sedation?
-Difficult to arouse but can w/ repeated verbal/pain stim
-May require help maintaining patent airway/ventilation
-CV function usu. maintained
Who can give local anesthesia and MINIMAL sedation?
Anyone - nurses, doctors, dentists..
Who can give things like moderate sedation or more?
Only people with specific credentials/training
What should be done if DEEP sedation/analgesia is required?
Anesthesia consult/presence during the procedure
What is the purpose of Credentialing for moderate sedation?
To allow for special procedures in areas outside the OR, w/o spcfc anesthesiologist involvement
What is ASA class I?
Normal and healthy
What is ASA class II?
Mild systemic disease with no limitation to daily activity
What is ASA class III?
Significant systemic disease that limits daily activity
What is ASA class IV?
Life-threatening systemic disease
What is ASA class V?
Obtunded, pre-morbid
What is ASA class VI?
Dead, organ donor
What monitoring is required during procedural sedation?
-Continuous HR/Pulse ox
-Intermittent BP/RR
Flowsheet/documentation
What are the discharge criteria after procedural sedation?
-Ambulating
-PO
-Able to void
(or back to baseline)
What is EMLA?
Lidocaine + Tetracaine - sits on the skin for cutaneous anesthia in 1 hr
What is LMX4?
4% lidocaine
What are EMLA/LMX4 used for?
Procedure Pain - venipunctures, etc..
What is Synera?
Lidocaine + Tetracaine in a gel pad
What can achieve cutaneous analgesia in 5 min?
Laser assisted drug delivery
What is DPT?
A lytic cocktail of demerol, phenothiazine and thorazine that is no longer used
What was DPT used for and why isn't it anymore?
Conscious SEDATION - it was painful on injection, prolonged sedation, and caused HYPOTENSION
What is commonly used for sedation in CT/MRI?
Chloral hydrate
What are 2 downsides to routine use of chloral hydrate?
-High failure rate
-Very bad taste
What happens at high doses of Chloral hydrate?
Respiratory depression
How can Chloral hydrate be given?
oral or rectally
What can provide longer lasting sedation for CT/MRI but can only be given IV?
Barbiturates
What gives RAPID onset/offset procedural sedation and can be given anyway route?
Midazolam
What Should be combined with midazolam for painful procedures? Why?
Opioids - BDZ's provide no analgesia
So what is given for PAINFUL procedural sedation?
Opioids
What 3 opioids?
Morphine
Fentanyl citrate
Meperidine
Why can we give Meperidine for procedural pain?
If only one dose, it won't likely cause seizures - that happens with BUILDUP of normeperidine
What are the top 2 drug choices for PAINLESS conscious sedation?
-Pentobarbital - IV
-Chloral hydrate - PO
What are you more likely going to give for consc. sedation in major procedures vs minor?
Opioids + BDZ - not just some EMLA or lidocaine LA
What should you consider for conscious sedation for major procedures?
GETA
What is an area of conscious sedation that is scary when not given by professionals?
Anesthesia drugs
What are the 3 anesthesia drugs drs are getting interested in?
-Ketamine
-Propofol
-Nitrous oxide
What type of drug is Ketamine? What does it provide?
Cyclohexylamine dissociative anesthetic - gives analgesia and amnesia
How is Ketamine metabolized?
By the liver
What receptors does Ketamine bind and how does it work?
mu-receptors
-NMDA antagonist
Disrupts communicn btwn limbic and thalamocortical areas
What effect does Ketamine have that none of the other IV anesthetics do?
Sympathomimetic - increases Epi - so increases HR/BP
What side effect does Ketamine cause? How do you counteract this?
Dissociative amnesia and hallucinations - give Midazolam
When should you NOT give Ketamine?
Head trauma - it increases CBF/ICP
What is a good thing about Ketamine's physiologic effects?
Does NOT depress respiratory - bronchoDILATES
Is Propofol safe to use for conscious sedation?
Yes but be prepared in case you lose the airway
What other IV anesthetic can be used for conscious sedation?
Nitrous oxide