Conscious and Deep Sedation in the ICU

Conscious and Deep Sedation in the ICU is a topic covered in the Pocket ICU Management.

To view the entire topic, please or purchase a subscription.

Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:

Anesthesia Central

-- The first section of this topic is shown below --

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
  • 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
  • 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

-- To view the remaining sections of this topic, please or purchase a subscription --

Last updated: April 15, 2010

Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Conscious and Deep Sedation in the ICU ID - 534225 Y1 - 2010/04/15/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534225/all/Conscious_and_Deep_Sedation_in_the_ICU PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -