Moderate Sedation for Non-anesthsiologists EXAM(Graded A+ actual test)

Objectives of Sedation Practice - Answer--Decrease Anxiety, pain, discomfort -Amnesia to the extent possible, but not guaranteed -Minimize risk (optimize risk/benefit ratio) -Rapid recovery Contraindications - Answer-History of allergy to medications Hemodynamic instability High risk of pulmonary aspiration of gastric contents High risk of sedation failure, requiring assistance of anesthesiology service Minimal sedation - Answer-Response to stim: normal/minimal Airway: Normal/minimal Spontaneous ventiliation: Normal/minimal Vital Signs: normal/minimal Moderate Sedation - Answer-Response: verbal/tactile Airway: None Spontaneous Ventilation: Adequate Vital Signs: normal/minimal Deep Sedation - Answer-Response: tactile/pain Airway: intervention often required Spontaneous Ventilation: possibly adequate Vital Signs: normal/minimalGeneral Anesthesia - Answer-Response: Unarousable Airway: Intervention Required Spontaneous Ventilation: Inadequate Vital signs: May be impaired Joint Commission Standards - Answer-Applies to moderate, deep, general, spinal or other major regional anesthia 'Must be able to manage compromised airway' What sedation level does not need to adhere to joint commission standards? - Answer-Minimal sedation EX: PO diazepam (valium) prior to MRI scan Sedation can cause -general considerations - Answer-Decreased hypoxic and hypercarbic respiratory drive • Decreased tone in upper airway leading to increased risk of upper airway obstruction • Decreased protective airway reflexes causing increased risk of pulmonary aspiration and laryngospasm Evaluation of the Airway - Answer-Quick Look Mouth Opening Mallampati score Neck extension Chin Size Mask Ventilation-Obese Score Tracheal Intubation-Lemon Score Mouth Opening - Answer-Three fingerbreadths between teeth Chipped, loose or missing teeth Ask about subluxation of jaw-'can you bite your upper lip?'Mallampati score - Answer-Relative tongue/palate size -Class I: predicts successful intubation -Class II and III: not predictive -Class IV: predicts difficult intubation Neck Extension - Answer-Minimum 35 degrees Limited extension may predict difficult intubation but not necessarily difficult ventilation Chin Size - Answer-•• Distance from upper border of thyroid cartilage to chin •• Should exceed three fingerbreadths or 6 cm •• Shorter distance associated with receding chin, short, thick neck, predicts difficult intubation, but not necessarily difficult ventilation Predictors of difficult MASK VENTILATION - Answer-Obese Score: -Obese -Bearded -Elderly -Snores -Edentulous