Moderate sedation
Patients requiring temporary sedation to facilitate diagnostic or therapeutic procedure
Sedation
any medication with sedative/hypnotic properties is capable of altering consciousness or protective reflexes
Training for Personnel
Should be able to recognize complications and b...
Moderate sedation
Patients requiring temporary sedation to facilitate diagnostic or
therapeutic procedure
Sedation
any medication with sedative/hypnotic properties is capble of
altering conciousness or protective reflexes
Training for Personnel
Should be able to recognize complications and be capable of
establishing a patient airway and positive pressure ventilation
Patient Monitor
an individual, other than the practiioner performin the procedure
should be present to monitor the patient through the operation with
sedation/analgesia during moderate sedation. they MAY assist with
minor, interruptable tasks one pation is stablized
Monitering Guildilnes
Level of consciousness:
- Response of patient to commands is a guide to level of
consciousness.
- Spoken = breathing
- Reflex only = deep sedation
Pulmonary Ventilation:
- Primary causes of morbidity are drug induced respiratory depression
and airway obstruction
Oxygenation
- Oximetry effectively detects oxygen desaturation and hypoxemia
- Supplemental oxygen should be present when sedation/analgesia is
administered
Hemodynamics
Regular monitering of vital signs in 5 min intervals, once sedation
is established.
Anesthetic induction agents
Propofol
Methohexital
Ketamine
Propofol and ketamine
, - can provide moderate sedation
- avoiding these meds will decrease likelyihood of adverse outcomes
though
JCAHO Agenda for Moderate Sedation
Standards held for sedated patients under anesthesia care must apply
to all sedated patients - Regardless of care giver
Goals of Moderate Sedation
1. Patient Responds to tactile stimulation
2. Maintains a Patient Airway
3. Maintains protective reflexes
4. Maintains CV homeostasis
Sedation Continuum
Moderate Sedation -> Deep Sedation -> General
Moderate sedation signs
purposeful response to command or tactile stimulation
Deep Sedation signs
not easily aroused, may have purposeful response to strong
stimulation, risk of ventilation/airway, and CV compromise
ASA classification
I Normal, healthy
II Mild systemic disease - no
limitation in daily activity
III Significant systemic
disease - limits daily
activity
IV Life threatening systemic
disease
V Pre-morbid condition
VI Organ harvest
Special Emphasis for Evaluation and Anesthetic Plan
- Airway
- Respiratory system
- Cardiovascular system
Airway Assesment
Physical Exam
History
Anatomical changes
Diagnostic testing
Mallampati Classification
Theyromental Distance
Atlanto-occiptal joint distance
Airway Assessment: History
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