Chapter 15: Sedation - Review Flashcards

Flashcards covering definitions of sedation levels, monitoring and safety standards, common medications and their effects, reversal agents, and typical sedation scenarios as described in Chapter 15: Sedation.

What does MAC stand for in anesthesia sedation and what does it entail?

Monitored Anesthesia Care; administration of medications by an anesthesia provider at any level of consciousness, with the ability to reverse effects and manage airway and cardiopulmonary status.

Define Minimal Sedation (Anxiolysis) as per ASA definitions.

Drug-induced state with normal response to verbal commands; cognitive function and coordination may be impaired; airway, ventilation, and reflexes are unaffected.

Define Moderate Sedation/Analgesia.

Drug-induced depression of consciousness with purposeful response to verbal or light tactile stimulation; no interventions required to maintain airway; spontaneous ventilation usually adequate; cardiorespiratory function usually maintained.

Define Deep Sedation.

Drug-induced depression of consciousness where the patient cannot be easily aroused but responds to repeated or painful stimulation; may require assistance to maintain a patent airway; spontaneous ventilation may be inadequate; cardiovascular function may be impaired.

Define General Anesthesia.

Drug-induced loss of consciousness with unresponsiveness to painful stimulation; patient is not arousable; airway maintenance and ventilation usually require support.

What are the standard ASA monitoring requirements during sedation?

Apply standard ASA monitors (blood pressure, heart rate, oxygen saturation) and continuously monitor ventilation and airway status, including EtCO2; have rescue equipment ready and monitor until recovery.

What is EtCO2 monitoring and why is it used during sedation?

End-tidal carbon dioxide monitoring used to continuously assess ventilation; helps detect hypoventilation or airway obstruction early.

What constitutes a thorough pre-sedation evaluation to reduce complications?

Focused physical examination with airway assessment and review of pertinent medical history; assess fasting status to minimize aspiration risk and determine suitability for sedation.

What equipment and readiness are recommended for sedation cases?

Resuscitation equipment, capability for positive pressure ventilation, suction, and reversal medications; ready to convert to general anesthesia if needed.

Name three commonly used sedative agents and a key characteristic for each.

Propofol: rapid onset and clearance; dexmedetomidine: analgesia with sedation and minimal respiratory depression; ketamine: dissociative anesthesia that preserves ventilation and cardiovascular stability.

What is a key property of dexmedetomidine as a sedative?

Provides sedation and analgesia without significant respiratory depression and preserves breathing; can cause bradycardia and hypotension.

What is unique about ketamine as an anesthetic agent?

Dissociative anesthesia that maintains airway reflexes and ventilation; may cause hallucinations, hypersalivation, and emergence delirium.

What are the roles and risks of benzodiazepines (e.g., midazolam) in sedation?

Reduce anxiety and provide amnesia; risk of paradoxical agitation in elderly; used for moderate/deep sedation but with respiratory depressant potential.

What are the benefits and risks of using opioids (e.g., fentanyl) during sedation?

Provide analgesia; rapid onset and clearance; can cause respiratory depression; effects are reversable with naloxone.

What are the reversal agents for opioids and benzodiazepines and what do they reverse?

Naloxone reverses opioids; Flumazenil reverses benzodiazepines.

Who should administer propofol according to ASA guidelines and why?

Propofol should be administered by an anesthesia provider due to its risk of causing hypotension and apnea.

What common procedures or settings rely on sedation outside the traditional operating room?

Gastrointestinal endoscopy and interventional GI procedures, interventional radiology (IR) procedures, magnetic resonance imaging (MRI) sedation, and regional blocks with sedation as needed.

What cardiovascular side effects are specifically associated with dexmedetomidine?

Bradycardia and hypotension.

What psychological and physical side effects are commonly observed with ketamine during emergence or recovery?

Hallucinations, hypersalivation, and emergence delirium.

What unique adverse reaction might benzodiazepines cause in elderly patients?

Paradoxical agitation.

What is the primary reason for assessing a patient's fasting status during a pre-sedation evaluation?

To minimize the risk of pulmonary aspiration.

Beyond medication administration, what critical responsibilities does an anesthesia provider have during Monitored Anesthesia Care (MAC)?

The ability to reverse effects and manage airway and cardiopulmonary status.