Moderate Sedation 100% CORRECT SOLUTIONS GRADE A+ ACCREDITED

Moderate sedation Patients requiring temporary sedation to facilitate diagnostic or therapeutic procedure Sedation any medication with sedative/hypnotic properties is capable of altering consciousness or protective reflexes Training for Personnel Should be able to recognize complications and be capable of establishing a patient airway and positive pressure ventilation Patient Monitor an individual, other than the practitioner performing the procedure should be present to monitor the patient through the operation with sedation/analgesia during moderate sedation. they MAY assist with minor, interruptable tasks one pation is stabilized Monitoring Guidelines Level of consciousness: - Response of patient to commands is a guide to level of consciousness. - Spoken = breathing - Reflex only = deep sedation Pulmonary Ventilation: - Primary causes of morbidity are drug induced respiratory depression and airway obstruction Oxygenation - Oximetry effectively detects oxygen desaturation and hypoxemia - Supplemental oxygen should be present when sedation/analgesia is administered Hemodynamics Regular monitering of vital signs in 5 min intervals, once sedation is established. Anesthetic induction agents Propofol Methohexital Ketamine Propofol and ketamine - can provide moderate sedation - avoiding these meds will decrease likelyihood of adverse outcomes though JCAHO Agenda for Moderate Sedation Standards held for sedated patients under anesthesia care must apply to all sedated patients - Regardless of care giver Goals of Moderate Sedation 1. Patient Responds to tactile stimulation 2. Maintains a Patient Airway 3. Maintains protective reflexes 4. Maintains CV homeostasis Sedation Continuum Moderate Sedation - Deep Sedation - General Moderate sedation signs purposeful response to command or tactile stimulation Deep Sedation signs not easily aroused, may have purposeful response to strong stimulation, risk of ventilation/airway, and CV compromise ASA classification I Normal, healthy II Mild systemic disease - no limitation in daily activity III Significant systemic disease - limits daily activity IV Life threatening systemic disease V Pre-morbid condition VI Organ harvest Special Emphasis for Evaluation and Anesthetic Plan - Airway - Respiratory system - Cardiovascular system Airway Assesment Physical Exam History Anatomical changes Diagnostic testing Mallampati Classification Theyromental Distance Atlanto-occiptal joint distance Airway Assessment: History - Previous problems with anesthesia or sedation - Sleep apnea, stridor, snoroing - RA Airway Assessment: PE Significant obesity? Short Neck? Small mouth opnening? Jaw issues? Airway Red Flags - Obesity/ Sleep apnea - Limited opening of mouth - Receeding Mandible - Pathology Respiratory Red Flags - Wheezing/ Chronic Pulmonary disease - Pneumonia - Dyspnea on exertion - Orthopnea No pulmonary reserve. Much greater than expected desaturation, hypoxemia, hypercarbia Requires significantly smaller incremental dosing Thyromental Distance The thyromental distance is the distance of the lower mandible in the midline from the mentum to the thyroid notch. This measurement is performed with the adult patient's neck fully extended, and helps one determine how readily the laryngeal axis will fall in line with the pharyngeal axis when the atlantooccipital joint is extended. If this thyromental distance is short ( 3 finger breadths, or 6 cm in adults), the laryngeal axis makes a more acute angle with the pharyngeal axis, and it will be difficult to achieve alignment. There is less space for the tongue to be displaced during laryngoscopy. Check that the floor of the mouth is pliable. Atlanto- Occipital Joint Distance Atlantooccipital joint extension may be measured when the head is held erect and facing forward. The angle between the erect and extended planes of the occlusal surface of the upper teeth is measured and equals the degree of atlantooccipital joint extension. The "normal" amount of extension equals 35 degrees. Almost all extension of the head on the neck takes place at the atlantooccipital joint. The atlas or the first cervical vertebra is a ring of bone. It does not have a body or spine which would hamper the backward continued......