Moderate Sedation ICU

Minimal Sedation (anxiolysis)

A drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected

Sedation and Analgesia (Moderate Sedation)

A drug-induced depression of consciousness during which patients respond purposefully to verbal commands (note reflex withdrawal from a painful stimulus is not considered a purposeful response) either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained

Deep Sedation (DS)

A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation is inadequate. Cardiovascular function is generally maintained.

Anesthesia

Consists of general anesthesia and spinal or major regional anesthesia. It does not include local anesthesia

ONLY IN ER

• ketamine

• etomidate

fentanyl

• initial dose: 50-100mcg bolus

• titration: 25 mcg increments q3-5mins PRN

• onset: 2-3min

• Duration: 30-60min

• MAX: 50mcg/min

meperidine (demerol)

• initial dose: 12.5-25 mg IV Bolus

• titration: 12.5 increments q5-15min PRN

• onset: 5-10min

• Duration: 1-2 hours

• MAX: 25mg/min

• Pearl: AVOID IN RENAL FAILURE → CNS toxicities (seizures)

Morphine

• initial dose: 2-5mg IV Bolus

• titration: 2mg increments

• onset: 5-10min

• Duration: 3-4 hours

• MAX: 1mg/min

midazolam

• initial dose: 1-3mg Bolus

• titration: 0.5-1mg increments q3-15min PRN

• onset: 1-5min

• Duration: up to 2 hours

• MAX: 1mg/min

Narcan

• initial dose: 0.2-0.4 IV over 5-10 seconds

• onset: 1-3min

• Duration: 40-60min

• frequency: q2-3min if rr </= 12 or if lvl. of consc. depressed

• MAX: 10mg

• OPIATE dependent: 0.1-0.2mg

SE of sedation

• respiratory depression

• orthostatic circulatory depression

• n/v

• constipation

• urine retention

• pruritis, urticaria (face and nose)

• change in ETCO2

• fentanyl - chest wall rigidity

diazepam

• initial dose: 2-5mg IV bolus

• titration: 1-2mg q 15-30min PRN

• elderly:

  • initial: 1-2mg IV bolus

  • tiration: 1mg increments

• onset: 2-5min

• Duration: >3 hours

• MAX: 5mg/min

propofol

• onset: 1min

• Duration: 20-30min

• NEVER ADMIN WITOUT INTUBATION

flumazenil

initial dose: 0.2mg IV over 15 seconds

2nd dose: 0.2mg; 45-60 seconds after

onset: 1-3min

duration: 45min

MAX: 1mg in one push; 3mg in 1 hour

Repeat Q60 secs until max dose PRN