Sedation is an induced reduction in conscious level, during which verbal contact is maintained with the patient.
Doctors in many specialties may be required to administer sedation. The doctor giving the sedation must not be also responsible for performing any procedure (such as manipulation of a dislocated joint). His sole responsibility is to ensure that the sedation is adequate, and to monitor the patient's airway, breathing, and circulation. Sedation is not a short cut to avoid formal anaesthesia, and it does not excuse the patient from an appropriate work-up or reasonable fasting. Monitoring is mandatory, and should include pulse oximetry.
It is easy for sedation to become general anaesthesia, with its attendant risks (see p 628). The loss of the eyelash reflex (gentle stroking of the upper eyelashes to produce blinking) is a good guide to the onset of general anaesthesia.
In the elderly,cognition after GA may persist for months: it is unknown whether lesser forms of anaesthesia can obviate this.
Agents
- Midazolam: Initial adult dose 2mg IV over 1min (1mg if elderly). Further 0.5-1mg IV as needed after 2min. Usual range 3.5-7.5mg (elderly max 3.5mg). SE: psychomotor function.18In some circumstances (eg manipulation of large joint; painful dressing changes) a narcotic analgesic may be used in addition (eg morphine in 1-2mg aliquots IV, or shorter acting opioids such as fentanyl), or small incremental doses of ketamine may be administered.
- Diazepam (as emulsion = Diazemuls: initial adult dose 2.5-10mg IV over 4min via a large vein.
Advertisements
