Sedation and Anxiolysis Protocols

CONSCIOUS SEDATION

PREPROCEDURAL AND INTRAPROCEDURAL CARE

At our institution, conscious sedation is administered by either two registered nurses or anesthesia technologists under the supervision of a physician. The goals of conscious sedation are to depress only minimally the level of the patient’s consciousness, to maintain a patent airway, and to allow the patient to respond to commands. Generally, emergency equipment such as oxygen, suction, monitors, Ambu bag, mask, and resuscitation drugs should be readily available. The patient should have an empty stomach (adults: NPO 4 to 6 hours before sedation, children: NPO 2 hours before sedation). During sedation, continuous monitoring of vital signs and oxygen saturation (normally above 95%) is needed. We record vital signs and oxygen saturation every 15 minutes. The level of consciousness of a patient is also continuously evaluated and recorded every 15 minutes according to a sedation scale as follows:

The following is a list of the most common drugs used for conscious sedation at our institution. This list details drugs administered intravenously. All drugs should be given slowly.

Parenteral Drugs

Pentobarbital Sodium (Nembutal)

This medication is used for sedation. It is probably the medication we use most. It results in rapid sedation given via either IV or IM routes. Its side effects include respiratory and cardiovascular depression. It should be avoided in patients with hepatic insuf ciency. If given I V, its onset is immediate; when given IM, its onset is within 10 to 15 minutes. Its effect lasts 15 to 20 minutes. We do not use it in children <6 months of age.

Morphine Sulfate

This medication is used for sedation and/or severe pain. It may result in nausea/vomiting and respiratory depression. Its antagonist is naloxone. It should not be given to patients with increased intracranial pressure or respiratory depression. Its effects peak between 20 and 60 minutes and may last 3 to 5 hours.

Fentanyl

This medication is used for pain and/or sedation. It may result in similar side effects as morphine and its antagonist is naloxone. Its onset is immediate and its effects last 30 to 60 minutes.

Demerol

This medication is used for patients with moderate-to-severe pain. Its side effects are similar to those of morphine and its antagonist is naloxone. Its onset is within 5 minutes of administration and its effect lasts 2 to 4 hours.

Midazolam (Versed)

The medication is used for sedation. It may result in cardiac and respiratory depression. Its antagonist is Flumazenil. Its onset of action is within 1 to 5 minutes after administration and its effect lasts 2 to 6 hours.