0071643192.pdf

CONTRAINDICATIONS

■ Lack of support staff or monitoring equipment
■ Comorbidities (ie, cardiac, hemodynamic, or respiratory compromise)
■ Recent (<2 hours) food intake

TECHNIQUE

■ Assess airway, cardiopulmonary status, gastrointestinal status (to prevent
aspiration).
■ Have necessary equipment in the room: O 2 , nonrebreather mask, bag-valve
mask, suction, oral airway, intubation materials including laryngoscope and
ET tubes, and cardiac resuscitation equipment and medications.
■ Monitoring is essential for procedural sedation: Oxygenation (via pulse
oximetry), ventilation (via capnography), and hemodynamic status (includ-
ing BP and cardiac rhythm) should all be monitored.
■ Informed consent should be obtained and documented for elective proce-
dural sedation in awake patients.
■ Give appropriate medication in appropriate doses to achieve level of pro-
cedural sedation (see Table 19.2).
■ Pharmacology (see Table 19.3)

COMPLICATIONS

■ Delayed awakening: Usually due to prolonged drug action, but consider
also hypoxemia or hypercarbia
■ Agitation: Usually due to pain, or paradoxical or emergence reactions
■ Nausea and vomiting: Sedative agents, premature administration of oral
fluids after procedure
■ Tachycardia: Pain, hypovolemia, impaired ventilation
■ Bradycardia: Vagal stimulation, opioids, hypoxia
■ Hypoxia: Laryngospasm, airway obstruction, oversedation PROCEDURES AND SKILLS

Ketamine should not be used

in patients with:

Closed head injury,

globe rupture,

recent URI.

TABLE 19.2. Continuum of Sedation and Analgesia (Levels of Procedural Sedation)

VENTILATORY CARDIOVASCULAR

LEVEL PATIENTRESPONSE RESPONSE RESPONSE

Minimal Anxiolysis Maintained Maintained

Moderate (formerly Depression of Maintained Maintained

“conscious sedation”) consciousness

Responds purposefully

to commands

Deep Not easily aroused May be impaired Maintained

Responds purposefully

to repeated stimuli

General anesthesia Cannot be aroused even Impaired May be impaired

by painful stimuli