MODERATE SEDATION 2026 FINAL EXAM QUESTIONS AND
ANSWERS RATED A+
✔✔Mallampati Class I - ✔✔Visualize the soft palate, uvula, anterior and posterior
tonsillar pillars
✔✔Mallampati Class II - ✔✔Visualize soft palate, fauces, uvula
✔✔Mallampati Class III - ✔✔-Visualize soft palate and base of uvula
-Need anesthesia consultation
✔✔Mallampati Class IV - ✔✔-The soft palate is not visible at all; only hard palate visible
-Need anesthesia consultation
✔✔Airway Assessment Considerations - ✔✔-Cervical Range of Motion
-Any restrictions with hyperextension of the head and neck
✔✔Instructions for patients well controlled on oral hypoglycemic receiving sedation for
short-term period (<1 hour) - ✔✔1. Do not take normally scheduled AM dose of
medication secondary to long-term effects of possible greater than 36h
2. Finger stick glucose prior to procedure and after the procedure
✔✔Instructions for well-controlled insulin dependent DM and for those procedures that
may last longer than 1 hour - ✔✔1. Consult anesthesia for medication
recommendations
2. Usually take normal dose of NPH evening prior and half prescribed AM dose the
morning of
3. Finger stick glucose every 30min. during the procedure and every hour during
recovery
✔✔Pre-op Assessment Neurologic System - ✔✔-H/O TIA, CVA, seizure disorder, head
trauma, convulsive disorder or epilepsy
-Assess general affect and behavior; speech pattern alterations; LOC; orientation; gait
-If local anesthesia is to be used, assess pre-existing numbness or weakness
✔✔Considerations for hyperthyroidism or hypothyroidism - ✔✔-Pharmacologic effects of
sedative and analgesics may be altered in these conditions
-Airway management may be more difficult in either situation and the thyroid gland may
be enlarged in hyperthyroidism and the tongue may be enlarged in hypothyroidism
✔✔Required Equipment for Sedation - ✔✔-Oxygen Source
-Suction
-Bag valve mask
-Airway adjuncts
,-IV access
-Emergency medications
-NIBP
-Pulse Oximeter
-Capnography
-Electrocardiograph
-Crash Cart
✔✔Minimal Oxygen Saturation - ✔✔95% on RA or supplemental O2
✔✔Considerations during Induction Phase - ✔✔-Continuous cardiac monitoring and VS
-Pre and post sedation rhythm strip
*LOC most important*
✔✔Supplemental O2 via NC - ✔✔-Volume of 1-6L/minute = 24-44% concentration of
O2
-FiO2 (% of oxygen) is increased by 4% for each L/Minute (Natural air FiO2 is 20%)
-Mouth breathing does not ablate effectiveness as O2 is entrained from the nose via
inspiratory flow through the posterior pharynx
✔✔Supplemental O2 via Simple Face Mask - ✔✔-Recommended for 8-10 Liters/min
(40-60%)
-Flow rate must be at least 5L/min to prevent CO2 rebreathing
✔✔Supplemental O2 via Face Mask with Reservoir - ✔✔-A flow of 6L/min will allow for
O2 concentrations of 60%
-A flow of 10L/min will allow for close to 100%
✔✔O2 delivery system recommended in acute and emergent situations - ✔✔Bag-valve
device
✔✔Airway Adjuncts for Sedation - ✔✔-Nasal Airway
-Oral Airway
✔✔Airway Adjuncts for Anesthesia - ✔✔-ETT (absolute control of airway)
-Laryngeal mask airway
✔✔Nasal Airway - ✔✔-Well tolerated by semi-conscious patient
✔✔Oral Airway - ✔✔-Must be measured properly
-Keeps the posterior pharynx open and prevents airway obstruction
-Only used with unresponsive patients as it can otherwise induce vomiting,
laryngospasm, or bronchospasm
-Airway is inserted backwards and rotated into position
, ✔✔Monitoring Parameters - ✔✔1. Respiratory rate and function
2. SaO2
3. BP
4. LOC
5. Skin condition
6. Continuously placed IV
✔✔Desirable Effects of Conscious Sedation - ✔✔-Relaxation
-Cooperation
-Diminished verbal communication
-Easy arousal from sleep
-Slurred speech is a good indicator of sedation (may or may not be seen)
✔✔Undesirable Effects of Conscious Sedation - ✔✔-Nystagmus as this indicates a
deeper level of sedation
-Agitation as this is a possible paradoxical effect
-Respiratory depression
-Autonomic responses such as increased HR and BP
✔✔Capnometer - ✔✔Provides a numerical measurement of carbon dioxide
✔✔Capnogram - ✔✔The waveform of carbon dioxide over a period of time
✔✔Capnography - ✔✔-The combination of a waveform and numerical value of ETCO2
-Measures the amount of carbon dioxide in respiratory gases
-Monitors ventilation, defined as the adequacy of respiration (how adequately the
patient is inhaling O2 and eliminating CO2)
-Provides breath-to-breath feedback so that changes in breathing are reflected
immediately
-Provides information about end-tidal carbon dioxide values, defined as maximal
concentration of carbon dioxide (CO2) at the end of an exhaled breath...The normal
values are 5% to 6% CO2, which is equivalent to 35-45 mmHg.
✔✔Capnography Numeric Values: Less than 35mmHg - ✔✔-
Hyperventilation/Hypocapnia
-pH increases
-Patient is being ventilated too fast
✔✔Pulse Oximetry - ✔✔-Measures oxygenation (concentration of oxygen in body)
-Can lag behind breathing changes
-Inaccurate at low oxygen saturation, low perfusion states, motion, ambient direct light
-Affected by ambient light, shivering, abnormal hemoglobin, Pulse rate and rhythm,
vasoconstriction, cardiac function
ANSWERS RATED A+
✔✔Mallampati Class I - ✔✔Visualize the soft palate, uvula, anterior and posterior
tonsillar pillars
✔✔Mallampati Class II - ✔✔Visualize soft palate, fauces, uvula
✔✔Mallampati Class III - ✔✔-Visualize soft palate and base of uvula
-Need anesthesia consultation
✔✔Mallampati Class IV - ✔✔-The soft palate is not visible at all; only hard palate visible
-Need anesthesia consultation
✔✔Airway Assessment Considerations - ✔✔-Cervical Range of Motion
-Any restrictions with hyperextension of the head and neck
✔✔Instructions for patients well controlled on oral hypoglycemic receiving sedation for
short-term period (<1 hour) - ✔✔1. Do not take normally scheduled AM dose of
medication secondary to long-term effects of possible greater than 36h
2. Finger stick glucose prior to procedure and after the procedure
✔✔Instructions for well-controlled insulin dependent DM and for those procedures that
may last longer than 1 hour - ✔✔1. Consult anesthesia for medication
recommendations
2. Usually take normal dose of NPH evening prior and half prescribed AM dose the
morning of
3. Finger stick glucose every 30min. during the procedure and every hour during
recovery
✔✔Pre-op Assessment Neurologic System - ✔✔-H/O TIA, CVA, seizure disorder, head
trauma, convulsive disorder or epilepsy
-Assess general affect and behavior; speech pattern alterations; LOC; orientation; gait
-If local anesthesia is to be used, assess pre-existing numbness or weakness
✔✔Considerations for hyperthyroidism or hypothyroidism - ✔✔-Pharmacologic effects of
sedative and analgesics may be altered in these conditions
-Airway management may be more difficult in either situation and the thyroid gland may
be enlarged in hyperthyroidism and the tongue may be enlarged in hypothyroidism
✔✔Required Equipment for Sedation - ✔✔-Oxygen Source
-Suction
-Bag valve mask
-Airway adjuncts
,-IV access
-Emergency medications
-NIBP
-Pulse Oximeter
-Capnography
-Electrocardiograph
-Crash Cart
✔✔Minimal Oxygen Saturation - ✔✔95% on RA or supplemental O2
✔✔Considerations during Induction Phase - ✔✔-Continuous cardiac monitoring and VS
-Pre and post sedation rhythm strip
*LOC most important*
✔✔Supplemental O2 via NC - ✔✔-Volume of 1-6L/minute = 24-44% concentration of
O2
-FiO2 (% of oxygen) is increased by 4% for each L/Minute (Natural air FiO2 is 20%)
-Mouth breathing does not ablate effectiveness as O2 is entrained from the nose via
inspiratory flow through the posterior pharynx
✔✔Supplemental O2 via Simple Face Mask - ✔✔-Recommended for 8-10 Liters/min
(40-60%)
-Flow rate must be at least 5L/min to prevent CO2 rebreathing
✔✔Supplemental O2 via Face Mask with Reservoir - ✔✔-A flow of 6L/min will allow for
O2 concentrations of 60%
-A flow of 10L/min will allow for close to 100%
✔✔O2 delivery system recommended in acute and emergent situations - ✔✔Bag-valve
device
✔✔Airway Adjuncts for Sedation - ✔✔-Nasal Airway
-Oral Airway
✔✔Airway Adjuncts for Anesthesia - ✔✔-ETT (absolute control of airway)
-Laryngeal mask airway
✔✔Nasal Airway - ✔✔-Well tolerated by semi-conscious patient
✔✔Oral Airway - ✔✔-Must be measured properly
-Keeps the posterior pharynx open and prevents airway obstruction
-Only used with unresponsive patients as it can otherwise induce vomiting,
laryngospasm, or bronchospasm
-Airway is inserted backwards and rotated into position
, ✔✔Monitoring Parameters - ✔✔1. Respiratory rate and function
2. SaO2
3. BP
4. LOC
5. Skin condition
6. Continuously placed IV
✔✔Desirable Effects of Conscious Sedation - ✔✔-Relaxation
-Cooperation
-Diminished verbal communication
-Easy arousal from sleep
-Slurred speech is a good indicator of sedation (may or may not be seen)
✔✔Undesirable Effects of Conscious Sedation - ✔✔-Nystagmus as this indicates a
deeper level of sedation
-Agitation as this is a possible paradoxical effect
-Respiratory depression
-Autonomic responses such as increased HR and BP
✔✔Capnometer - ✔✔Provides a numerical measurement of carbon dioxide
✔✔Capnogram - ✔✔The waveform of carbon dioxide over a period of time
✔✔Capnography - ✔✔-The combination of a waveform and numerical value of ETCO2
-Measures the amount of carbon dioxide in respiratory gases
-Monitors ventilation, defined as the adequacy of respiration (how adequately the
patient is inhaling O2 and eliminating CO2)
-Provides breath-to-breath feedback so that changes in breathing are reflected
immediately
-Provides information about end-tidal carbon dioxide values, defined as maximal
concentration of carbon dioxide (CO2) at the end of an exhaled breath...The normal
values are 5% to 6% CO2, which is equivalent to 35-45 mmHg.
✔✔Capnography Numeric Values: Less than 35mmHg - ✔✔-
Hyperventilation/Hypocapnia
-pH increases
-Patient is being ventilated too fast
✔✔Pulse Oximetry - ✔✔-Measures oxygenation (concentration of oxygen in body)
-Can lag behind breathing changes
-Inaccurate at low oxygen saturation, low perfusion states, motion, ambient direct light
-Affected by ambient light, shivering, abnormal hemoglobin, Pulse rate and rhythm,
vasoconstriction, cardiac function
