1. Conscious Sedation
March, 2012

2. Moderate Sedation Patient maintains: Airway Spontaneous ventilation
Responds to verbal commands or light tactile stimulation “Ramsey 3”
Cardiovascular function maintained
Drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.

3. Deep Sedation Patients response May need assistance to maintain airway
Stimulation to elicit a response may need repeated to obtain purposeful response (Ramsey 4, 5, 6)
Sometimes the patient may go from moderate to deep sedation
Cardiovascular function is usually maintained
Drug-induced depression of consciousness during which patients cannot be easily aroused, but respond purposefully following repeated or painful stimulation. Ability to independently maintain ventilatory function may be impaired.

4. Procedures that require sedation per Lake Health policy
Moderate sedation:
Transesphogeal echocardiogram
Endoscopy
PEG placement

5. Procedures that require sedation per Lake Health policy
Deep sedation:
Elective cardioversion

6. Preprocedure Preparation
Current H&P
Physician assessment of airway and ASA status (American Society of Anesthesiology)
Any previous problems with intubation, sleep apnea, and/or complications with anesthesia
Informed consent
IV access
NPO status

7. During the procedure
Ongoing monitoring of level of consciousness, vital signs, oxygenation/ventilation, ECG, pain
Nurse monitoring patient stays in the room during the procedure

8. Post Procedure Monitor; LOC and emotional state
Oxygenation/ventilation
Vital signs
ECG
Pain assessment

9. Post procedure cont.
BP, HR, RR within +/- 20% of patient’s normal range
O2 sat >95% or within 5% of patient’s baseline
Arouses easily and when aroused is able to respond appropriately for his/her age
Significant complications related to the specific procedure are absent, have been controlled, or have been evaluated
Wound drainage, N & V, Bladder distention, compromised neurovascular status.

10. Documentation Conscious sedation record is used
Assessment parameters are documented at 5 minute intervals during the procedure and for 30 minutes post procedure at the minimum
If patient does not return to baseline cont. every 15 minutes VS until patient back to baseline or physician determines patient is stable

11. Documentation cont.
IF DEEP SEDATION is planned, Anesthesia uses the Anesthesia record for the history, medications and airway assessment.

12. Important to remember
If you are performing an elective cardioversion you must have anesthesia present prior to starting the procedure

13. TIME OUT
A time out MUST be performed with all involved parties present and is documented on the Conscious Sedation Record!!!!!

14. Most common Medications used during the procedure
Midazolam Hydrochloride (Versed)
Morphine
Demerol
Fentanyl
Diazepam
Propofol (Diprivan)

15. Dosing for medications during the procedure
Versed (midazolam) for moderate sedation:
0.5 mg – 2.5 mg
Versed for deep sedation:
0.5 mg -3.5 mg in incremental doses until desired level of sedation

16. Dosing for medication during procedure (con’t)
Fentanyl: ug ( ug/kg)
Diazepam: 1-10 mg

17. Dosing for medications during the procedure:
Morphine: 2-10 mg ( mg/kg)
Demerol: 25mg – 100mg ( mg/kg)
Diprivan (propofol): Variable doses administered by the anesthesiologist during deep sedation

18. Medications to treat overdose
Narcan: used to treat opiod/narcotic overdose
Usual dosing: 0.1mg to 0.2mg IV, IM
repeat dose every 2 minutes until patient responds not to exceed 10mg
Romazicon: used for benzodiazepine overdose
Usual dosing: 0.2mg over 15 seconds
May repeat every 1 minute with 0.2mg over 15 seconds times 3

19. 1. During moderate sedation patient maintains:
Airway, spontaneous ventilation, responds to verbal commands, cardiovascular function
Needs mechanical ventilation
Responds to painful stimuli, needs respiratory support
Maintains no function

20. 2. Prior to conscious sedation pre-procedure preparation includes:
No consent needed
Patient had breakfast
Current H&P, physician assessment of airway, informed consent, IV access, NPO status
No preparation

21. 3. During procedure nurse must stay in room with patient to monitor
True
False

22. 4. Post Procedure nurse will monitor:
Pain assessment
LOC, oxygenation, vital signs, ECG, pain assessment
LOC only
BP & Pulse only

23. 5. Documentation includes:
Neuro flowsheet
ADL’s flowsheet
Use of conscious sedation form
None of the above

24. 6. A time out must be performed prior to conscious sedation
True
False