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