Procedural sedation: Difference between revisions

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**If titrate to deep sedation, when painful stimulus stops may become apneic
**If titrate to deep sedation, when painful stimulus stops may become apneic
*Duration = 30min
*Duration = 30min
===Etomidate/Fentanyl===
*Similar to versed/fentanyl but better b/c of shorter duration of action
*Good for brief sedation if don't have access to propofol
**E.g. shoulder/hip reduction, cardioversion
*Dose fentanyl first: 0.5-1mcg/kg
*Etomidate 0.15mg/kg (8-10mg avg)
**Wears off in 6min
===Ketamine===
===Ketamine===
*Ideal for extended procedural time, complete analegesia, muscle relaxation
*Ideal for extended procedural time, complete analegesia, muscle relaxation
*Avoid in elderly, hypertensive, baseline psych
*See [[Ketamine]]
 
===Ketamine===
[[Ketamine]]
 
Sympathomimetic - avoid in old, hypertensive, baseline crazy/psych
 
===Etomidate + fentanyl===
Good for brief sedation if don't have propofol
shoulder/hip reduction, cardioversion
for short lived but painful procedure
Dose fentanyl first: 0.5-1mcg/kg  analgesia
Etomidate 0.15mg/kg (8-10 on avg.. if not enough then give additional 4mg boluses)
by 6 min wears off
sedation of profound sedative agent matches the length of time of the stimulus
Hemodynamically stable for pt
 
just like versed/fentanyl but better b/c it disappears faster
what about myoclonus? - usually mild
either let it wear off or can try to give versed to stop it


===Propofol===
===Propofol===
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==Side Effects==
==Side Effects==
Dropping sats
#Desaturation
1. Stimulate
##Stimulate
2. Jaw thrust
##Jaw thrust
3. Nasal airway
##Nasal airway
4. BVM (just 10 breaths/min) count to 5 between breaths
##BVM (just 10 breaths/min) count to 5 between breaths
5. NIV
##NIV
6. LMA
##LMA
7. Intubation
##Intubation
 
==Source==
EMCrit Podcast 29

Revision as of 18:44, 11 July 2011

Background

  • Placing pt on ETCO2 + SpO2 is best
    • If do not have ETCO2 consider placing pt on room air alone
      • Works as indirect measure of ventilation (as CO2 incr, SpO2 decr)
  • Position pt in position you would intubate them (ear at level of sternal notch)
  • Consider nasal airway in pt with likely OSA

Sedation Levels

  • Minimal Sedation
    • Pain meds
  • Moderate Sedation
    • Pt awake, pt able to respond to questions
    • LP, I+D
  • Deep Sedation
    • If give pt painful stimuli they will react purposefully
    • Reduction,
  • General Anesthesia
    • Unarousable

Agents

Fentanyl/Versed

  • Designed for moderate sedation
    • If titrate to deep sedation, when painful stimulus stops may become apneic
  • Duration = 30min

Etomidate/Fentanyl

  • Similar to versed/fentanyl but better b/c of shorter duration of action
  • Good for brief sedation if don't have access to propofol
    • E.g. shoulder/hip reduction, cardioversion
  • Dose fentanyl first: 0.5-1mcg/kg
  • Etomidate 0.15mg/kg (8-10mg avg)
    • Wears off in 6min

Ketamine

  • Ideal for extended procedural time, complete analegesia, muscle relaxation
  • See Ketamine

Propofol

Propofol

Side Effects

  1. Desaturation
    1. Stimulate
    2. Jaw thrust
    3. Nasal airway
    4. BVM (just 10 breaths/min) count to 5 between breaths
    5. NIV
    6. LMA
    7. Intubation

Source

EMCrit Podcast 29

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