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IV Sedation - Coggle Diagram

- - - - give verbal encouragement
        
        "you'll be able to enjoy food again"
        
        commending the patient for being calm and compliant
- - - - Mild
        
        140/90
      - Moderate
        
        160/95
      - Severe
        
        200/115
        
        Refer to GP
    - - Ideally class 1 or 2
        
        A normal healthy adult
        
        an adult with mild systemic disease
    - - 110 per minute
        
        will be higher due to dental anxiety
      - less than 60, higher than 110
        
        Worthy of further management
    - - Normally between 16-20 per minute
        
        Can be higher due to anxiety
    - - If Severely overweight or underweight
        
        high risk for sedation
    - - Mild Asthma can be treated
        
        Pt must bring their inhaler
      - Diabetes
        
        Do not treat uncontrolled diabetes
        
        HbC
      - Pregnancy
        
        avoid sedation
      - Illegal Drug Use by the patient must be kept in mind
      - Cardiovascular conditions
        
        For most conditions these should be managed at a hospital setting.
      - chronic Obstructive Pulmonary Disease
        
        Respiratory depression from Midazolam can be greater
      - Avoid Neurological disorders
        
        myasthenia gravis
        
        weak resipiration
  - - - Cannot drive afterwards
      - patient should be discharged to another adult
  - - - measure the percentage of heamaglobin with bound O2
    - - the first indicator that breathing has stopped
  - - - benzodiazepine
        
        Lorazepam
        
        Pt could need higher dosage due to tolerance/resistance of receptors
        
        Pt could need lower dose due to existing medication in blood.
      - Monoamine oxidase inhibitors (M.A.O.I.)
    - - Opiates already depress the respiratory system
        
        Do not use Midazolam, as the respiratory depression can be dangerous
- - - - must have oxygen available for adminsitration
      - monitored with pulse oximentry
- - - - always palpate
      - aim for superficial veins to reduce risk
    - - manage with heat pack
      - massage
    - - Pt can be hospitalized if large amount is deposited
      - blanching of skin
      - severe burn
      - inject lignocaine
  - - - draw one ampoule of 5 mg/5ml into syringe
        
        can dilute with water if needed.
    - - oximetry, BP, HR
    - - ideally radial to avoid injection into the brachial artery
    - - check for hypersensitivity, allergy
    - - check for signs and symptoms of drug effect
        
        loss of fear
        
        slurred speech
        
        nystagmus
        
        eyes moving side to side
        
        drowsiness
        
        ptosis
- - - - Dosage
        
        Comes in tablets or ampoules
        
        ampoules
        
        15 mg in 3 ml
        
        5mg in 5 ml
        
        7.5 mg tablets
        
        effective for most adults in the 1-8 mg range
        
        much less is needed in elderly people
        
        Inject slowly
        
        "titration"
        
        recommended not to go past 10 mg
        
        average of 7 mg
      - the most lipid soluble benzodiazepine
        
        higher rate of absorption into the brain
      - Anterograde amnesia
        
        perception not effect
        
        memory is significantly affected
        
        10 mins of good amnesia
        
        followed by up to an hour of less significant amnesia
        
        pts don't remember the injections
      - muscle relaxation
        
        must make sure the chin does not move to an area of airway obstruction
      - 1-3 min before onset starts
      - lasts about 30 mins
    - - anxiolytic effect
        
        No analgesic effect
        
        Pain is associated to anxiety
        
        reduced anxiety effect makes patients feel like midazolam helps with pain
      - Reduced Gag reflex
    - - Metabolised in the Liver
      - Urine Excretion
      - half-life of 2-4 hrs
  - - - Start with 0.1mg
      - Increments of 0.1mg
        
        up to 1 mg in total
- - - - Loss of consciousness would be considered GA