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Conscious Sedation

Conscious Sedation. By Dr. L. Saarmann, RN. Drugs . Opioids MS(morphine), fentanyl Barbiturates Nembutal, brevital Intravenous anesthetics . IV Anesthetics . ketamine [Ketalar ] Rapid acting Derived from phencyclidine Acts on reticular formation

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Conscious Sedation

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  1. Conscious Sedation By Dr. L. Saarmann, RN

  2. Drugs • Opioids • MS(morphine), fentanyl • Barbiturates • Nembutal, brevital • Intravenous anesthetics

  3. IV Anesthetics • ketamine [Ketalar] Rapid acting • Derived from phencyclidine • Acts on reticular formation •  analgesia, amnesia, no muscle relaxation so pt can move on command • Produces dissociative anesthesia (pt is awake but detached from environ) • good for short procedures • SE: HTN, inc pulse, inc secretions, Emergence rxn (HIGH), Flashbacks • Nursing: • Contraindicated for HTN, increased ICP, psychiatric history, ETOH abuse • Monitor VS & mental status • Protect from stimuli when they are emerging from anesthesia • propofol [Diprivan] • Action unknown Killed Michael Jackson • Contraindications: • sensitivity to soybean, egg, lecithin, glycerol • Not for pts with increased ICP or Labor and delivery pt • SE: • pain, burning, hypotension, bradycardia, apnea, bucking, clonic/myoclonic movements

  4. Benzodiazepines • midazolam [Versed]crosses BBB • Anesthesia and amnesia • Action: interferes with reuptake of GABA (inhibitory neurotransmitter) • SE: • amnesia, phlebitis, laryngospasm, • respdepression, cardiac arrest. • Nursing: • monitor VS • decrease Versed dose if narcotic analgesia is also used • half life prolonged in obese pts

  5. Reversing agents • For Opiates = naloxone [Narcan] • For Benzodiazepines = flumazenil [Romazicon] • 1-2 minute onset • 1-2 hour peak so make sure benzo doesn’t last longer

  6. use sedation scales so you know when to stop or start sedatives

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