Conscious and Deep Sedation in the ICU
First Things First (assess & treat for the following)
- Determine depth of sedation/analgesia required for procedure/intervention:
- Minimal sedation (anxiolysis)
- Responsiveness: normal response to verbal stimuli
- Airway: unaffected
- Spontaneous ventilation: unaffected
- Cardiovascular function: unaffected
- Moderate sedation (conscious sedation)
- Responsiveness: purposeful response (not withdrawal) to verbal or tactile stimulation
- Airway: no intervention required
- Spontaneous ventilation: adequate
- Cardiovascular function: usually maintained
- Deep sedation/analgesia
- Responsiveness: purposeful response (not withdrawal) to repeated or painful stimuli
- Airway: intervention may be required
- Spontaneous ventilation: may be inadequate
- Cardiovascular function: usually maintained
- General anesthesia
- Responsiveness: unarousable even w/ painful stimuli
- Airway: intervention often required
- Spontaneous ventilation: frequently inadequate
- Cardiovascular function: may be impaired
- Minimal sedation (anxiolysis)
- Who will monitor pt during conscious sedation?
- A designated individual, other than the practitioner performing the procedure, should monitor the pt throughout the procedure for moderate to deep sedation.
- During moderate sedation, may assist w/ minor interruptible tasks once level of sedation is stable
- During deep sedation, should be responsible only for monitoring pt
- Who should provide sedation/analgesia for conscious sedation?
- Individual must:
- Understand pharmacology of agents to be used
- Understand role of pharmacologic antagonists
- Recognize associated complications, to include ventilatory insufficiency, airway obstruction, excessive level of sedation
- Individual present capable of establishing airway & positive-pressure ventilation
- Individual w/ advanced life support skills must be immediately available (< 5 min) for moderate sedation & in room for deep sedation
- Individual must:
- What equipment should be available during conscious sedation?
- Appropriate sizes of following items for infants, pediatrics, adults:
- IV equipment
- IV fluids
- Catheters, tourniquets, gloves, etc.
- Basic airway mgt equipment
- Source of compressed oxygen
- Suction, suction catheters
- Face masks
- Self-inflating breathing bag-valve set
- Oral/nasal airways
- Lubricant
- Advanced airway mgt equipment
- Laryngeal mask airway
- Laryngoscope handles/blades
- ETTs
- Stylet
- Pharmacologic antagonists
- Naloxone
- Flumazenil
- Emergency meds
- Epinephrine, ephedrine, vasopressin, atropine
- Nitroglycerin, amiodarone, lidocaine
- Glucose 50%
- Diphenhydramine
- Hydrocortisone or dexamethasone
- Diazepam or midazolam
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Last updated: April 15, 2010
Citation
"Conscious and Deep Sedation in the ICU." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534225/all/Conscious_and_Deep_Sedation_in_the_ICU.
Conscious and Deep Sedation in the ICU. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534225/all/Conscious_and_Deep_Sedation_in_the_ICU. Accessed November 5, 2024.
Conscious and Deep Sedation in the ICU. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534225/all/Conscious_and_Deep_Sedation_in_the_ICU
Conscious and Deep Sedation in the ICU [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2024 November 05]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534225/all/Conscious_and_Deep_Sedation_in_the_ICU.
* Article titles in AMA citation format should be in sentence-case
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T1 - Conscious and Deep Sedation in the ICU
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