DENTAL ANESTHESIOLOGY - Sedation Dentistry Michigan, Sedation
Alan Hope -1- Safe Sedation
Transcript of Alan Hope -1- Safe Sedation
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Endoscopy – Safe Sedation
Dr Alan Hope
Western Infirmary, Glasgow
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Safe Sedation – the problem
Unpleasant procedures are not good …
… for the patient: non-cooperation,
hypertension, tachycardia, angina, retching
and vomiting, bronchospasm, coughing,
straining etc etc
… for the doctor: poor conditions for
procedure, failure of procedure.
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The solution: Sedation
What clinical state do I aim to achieve?
What do I give?
How do I give it?What might go wrong?
What do I do then?
Will the judge’s summing up besympathetic?
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The plan =
“Conscious Sedation”
Awake, apprehensive.
Drowsy, communicating, cooperative – awake to speech.
Very Drowsy, uncooperative.
Difficult to rouse, obstructed
respiratory pattern.Comatose, profoundly depressed
respiration, cyanosis.
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Safe Sedation - principles
Preparation: anticipate and prevent
problems
Know your drugs
If in doubt – don’t proceed, get advice
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Safe Sedation – before you start
Check equipment: Suction, oxygen,ambubag, airways, defibrillator, tippingtable / trolley.
Monitors: ECG, SaO2 (alarm at 90%),NIBP, competent assistant
Drugs: including naloxone, flumazenil,
resuscitation drugs.Patient: ?hypovolaemic, reliable IV (expose
cannula), position.
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Safe Sedation - drugs
Benzodiazepines
Opioids Intravenous anaesthetic agents (propofol)
Nitrous oxide
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Safe Sedation - midazolam
A benzodiazepine: sedation, hypnosis,unconsciousness, loss of muscle tone,amnesia, no analgesia, resp depression at
high doses, occasionally agitation / aggression.
GABA agonist, depresses limbic system.
Technique: titrate (0.5-2mg boluses) to anendpoint (slurred speech), supervise for 1hrafter injection, accompanied home.
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Safe Sedation - pethidine
An opioid. Half-life 2.5-4h.
Sedation, analgesia, respiratory depression,
nausea, CVS stable, v. occ. histamine
release.
Mu agonist.
Technique: give 10-25mg IV increments to1-1.5mg/kg, depending on age, medication
(MAOIs!), renal function, body size,
conscious level, respiratory status.
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Not-so-safe Sedation –
airway obstruction
Snoring, paradoxical “see-saw” chest
movement, poor air entry, cyanosis
Airway manoeuvres / insert airway
Oxygen
No prompt resolution – give antagonists and
call for help.
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Not-so-safe Sedation –
profound respiratory depression
Rate into low single figures
Give no more sedation, start oxygen
Shake patient, and tell patient to breathe
If “losing it” support respiration, give
antagonists, call for help
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Safe Sedation - summary
Know drugs, effects, side effects
Prepare: equipment, monitoring, antagonists
Don’t rush - slow titration of drugsHave a game-plan for clinical problems,
you may need to move quickly
You are responsible until patient has fullyrecovered from your sedation