1.1 Conscious Sedation

medications

Conscious Sedation (CS)

A combination of medicines to help a patient relax and block pain during a procedure, with no loss of protective reflexes, is awake, and can maintain own airway while being able to respond to verbal commands.

3 main goals for conscious sedation for the patient to be in

pt at no time loses protective reflexes

pt retains own open airway

respond to verbal and physical stimulation

what is syndrome x angina

A condition characterized by chest pain or discomfort due to coronary artery disease, where patients experience angina-like symptoms from microvascular dysfunction but do not have significant blockages in their coronary arteries.

what is prinzmetal angina

A type of chest pain caused by temporary spasms of the coronary arteries, leading to reduced blood flow to the heart. It often occurs at rest and can be associated with stress or smoking.

how do anti inflammatory analgesics work

examples 3 examples of these meds

anti inflammatory

reduce inflammation at site of pain

acetaminophen

aspirin

COX inhibitors

NSAIDS- ibuprofen & naproxen

Meperidine (Demoral) dosage and class

10-20 mg

opioid

hydrochloride salt synthetic form of opioid

Reversal: Narcan

Fentanyl brand name

Sublimaze

Most conscious sedation medications have a onset time between

1-3 min.

Fentanyl (sublimaze)

Dose

duration

Reversal

50-100 mcg

10-15

Narcan

Meperidine brand name

Demerol

versed

brand name

class

function ?

midazolam

benzodiazepines

sedation

enhances binding effects of GABA on GABA-A receptors enhancing the opening fq of chloride channels

Versed reversal brand and trade name

Romazicon (Flumazenil)

Midazolam (Versed) dosage

0.5-1 mg

What is a drug antagonist

whats it due and hows it do it

molecule that opposes or blocks the action of a substance at a receptor site.

blocking

competing

reversing agonist effects (displace agonist)

dosage for romazicon

brand name

function

0.2-1 mg

(flumazenil)

antagonist to benzodiazepine receptors (blocks the action of a substance at a receptor site)

Romazicon brand name

Flumazenil

morphine

dosage

whats it do and affect

2-4 mg

affects CNS to inhibit pain

How do analgesic opioids (narcotics) work

examples..

changing brains perception to pain

codeine

fentanyl

hydrocodone

meperidine

methadone

oxycodone

Deep Sedation

A sedation level where the patient has no response to verbal stimulation and may require intervention for airway management.

General Anesthesia

A sedation level where the patient is completely unresponsive and requires intervention for airway management.

Pre-procedural Assessment

An evaluation conducted before a procedure to identify any pre-existing conditions and assess patient readiness for sedation.

Mallampati Classification

An airway assessment tool used to predict the ease of intubation based on the visibility of throat structures.

ASA Classification

A system developed by the American Society of Anesthesiologists to classify a patient's physical status and determine eligibility for conscious sedation.

Aldrete Score

A scoring system used to assess a patient's recovery from anesthesia based on criteria such as respiration, oxygen saturation, consciousness, circulation, and activity.

NPO

A medical abbreviation meaning "nil per os," indicating that a patient should not consume food or liquids before a procedure.

Morphine

A medication used for pain management during sedation, with a typical dose of 2-4 mg.

Meperidine (Demerol®)

A pain management medication used in conscious sedation, typically dosed at 10-20 mg.

Fentanyl (Sublimaze®)

A potent pain medication used in conscious sedation, with a common dose of 25-50 mcg.

Midazolam (Versed®)

A sedative used to reduce anxiety during procedures, typically dosed at 0.5-1 mg.

Narcan® (Naloxone)

A medication used for the reversal of opioid effects, administered at a dose of 0.04 mg.

Romazicon® (Flumazenil)

A medication used for the reversal of benzodiazepine effects, typically dosed at 0.2-1 mg.

1. The patient at no time loses protective reflexes

2. the patient retains the ability to maintain an open airway continuously without help

3. The patient responds appropriately to verbal and physica

What criteria define conscious sedation?

1. preprocedural baseline assessment

2. drug dosage and administration

3. patient monitoring

4. post procedure monitoring and assessment and discharge criteria

What are the four (4) major components of conscious sedation protocol?

oxygen saturation, spontaneous bilateral chest rise and fall, or if possible auscultation of breath sounds.

How can you monitor pulmonary ventilation?

fentanyl

25-50 mcg

midazolam

0.5-1 mg

morphine

2-4mg

What are the recommended dosages of the following medications:

• Fentanyl

• Midazolam

• Morphine

fentanyl narcotic analgesic

time onset: 1min

duration: 10-15min

dose: 25 µg (microgram)

reverse agent : Naloxone (Narcan)

dose : 0.04mg or 1ml

What is time of onset for Fentanyl? What is the reversal agent for Fentanyl?

Midazolam (Versed@))sedative, amnesic)

Dose: 0.5-1.0 mg

onset: 1-3 min

reversal agent: Flumazenil (romazicon@)

What is the time of onset for Midazolam? What is the reversal agent for Midazolam?

Premedicated with prednisone and diphenhydramine (benadryl)

pretreatment with corticosteroids to alleviate reactions to IV contrast media has been found to be helpful in reducing all forms of reactions but not those characterized by hives.

pt with a known prior anaphylactoid reactions to contrast dye should be pretreated with steroids and an h2 blocker.

What medications can be given preoperatively for allergies to contrast media?

keep patient hydrated and maintenance of large volume urine flow > 200 ml/h. constant monitoring of urine output. Nonionic or low osmolar contrast agents have lower incidence of contrast induced nephropathy than ionic agents. limit of 5mL of contrast per kg of body weight/SCr (serum creatinine, mg/dL)

What are some ways to prevent contrast induced nephropathy

1. cutaneous and mucosal manifestation

2. smooth muscle and minor anaphylactoid responses

3. cardiovascular and major anaphylactoid responses

What are the three types of contrast allergies

The purpose of conscious sedation (sedative + anesthetic) is a controlled level of unconsciousness that allows the patient to remain independent for circulation, ventilation, and a level of responsiveness. The cost and recovery time post procedure are lower and with less complications. General anesthesia causes the patient to be unresponsive even to painful stimuli, require artificial ventilation, and possible impaired cardiovascular function.

What is the purpose of conscious sedation? Why isn't general anesthesia routinely used?