Conscious and Deep Sedation in the ICU

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

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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

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Last updated: April 15, 2010