Conscious sedation : pharmacology
What are the two broad levels of sedation technique in the UK for training purposes?
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Basic and advanced.
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What are the basic sedation techniques in the UK?
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Inhalation sedation with nitrous oxide for all ages, and midazolam sedation (any route) for people aged 12 years or older.
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What are some examples of advanced sedation techniques in the UK?
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Midazolam sedation (any route) for people under 12 years old, combined routes of administration, combined drugs, and drugs like ketamine and propofol.
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What are the four levels of sedation when using drugs?
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Minimal sedation, moderate sedation, deep sedation, and general anaesthesia.
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How does nitrous oxide work to produce sedation?
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By enhancing the activity of inhibitory neurotransmitters like GABA in the central nervous system.
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How do benzodiazepines like midazolam produce sedation?
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By enhancing the activity of the inhibitory neurotransmitter GABA in the central nervous system.
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Why is it particularly important to monitor patients receiving propofol closely?
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Because respiratory depression and hypotension can occur, particularly with rapid bolus dosing or high doses.
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How can the effects of opioids be reversed if problems occur during sedation?
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By using opioid antagonists like naloxone.
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What are some potential side effects of ketamine?
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Side effects including hallucinations, agitation, and nausea and vomiting.
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When do side effects like nausea and vomiting commonly occur with sevoflurane?
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Particularly during induction or emergence from sedation/anaesthesia.
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What class of drug can increase the effects of benzodiazepines leading to increased sedation?
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Antidepressants
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What class of drug can increase the metabolism of sedative drugs leading to reduced effectiveness?
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Anti-seizure medications like carbamazepine and phenytoin.
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What is first pass metabolism?
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When a drug administered orally must pass through the GI tract and liver before entering the bloodstream, reducing its bioavailability.
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Why does IV administration provide the most rapid onset of action?
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Because the drug goes directly into the bloodstream.
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Why can co-administration of sedative drugs lead to respiratory depression?
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Due to additive or synergistic effects on the receptors in the brain.
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Why are infusions used for some sedative drugs?
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To help maintain steady drug levels in the blood compared to bolus dosing.
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What is the principle of minimum intervention?
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Using the smallest dose of the fewest drugs needed to achieve sedation goals while minimising risk.
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What are some factors to consider when selecting sedative agents?
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Age, weight, anxiety level, medical history, and healthcare environment.
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Why should certain sedatives be avoided in patients with respiratory disease?
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Because they are at higher risk of respiratory depression.
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What neurotransmitter do benzodiazepines enhance to produce sedation?
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GABA (gamma-aminobutyric acid)
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What makes midazolam a useful sedative agent?
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Its rapid onset and short duration of action.
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What class of medications are fentanyl, remifentanil, and sufentanil?
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Potent synthetic opioids.
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How does ketamine produce sedation?
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By blocking the neurotransmitter glutamate in the brain.
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Why is ketamine useful for patients with respiratory or cardiovascular disease?
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It does not cause significant respiratory depression or hypotension.
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What class of drug is sevoflurane?
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A volatile anaesthetic.
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How can combining midazolam and opioids increase risk?
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By increasing respiratory depression and hypotension.
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Why should patients on antidepressants be monitored with sedation?
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They can increase sedative effects.
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Why does IV administration have a short duration?
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The drug is not stored in tissues.
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Why should dose be reduced in elderly patients?
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Due to reduced drug metabolism and clearance.
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Why is medical history important for sedation?
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To identify conditions, medications, or allergies that may interact.
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What is required for professionals administering sedation?
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Proper training and experience.
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What increases risk with bolus midazolam?
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Inability to titrate doses to the patient.
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Why adjust nitrous oxide flow for paediatric patients?
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Differences in lung capacity.
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Why avoid propofol in severe hypotension?
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It can further lower blood pressure.
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Why monitor cardiovascular disease patients closely?
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Increased risk of blood pressure or heart rate issues.
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