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Intravenous Sedation |
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1. Perform a relevant clerking procedure. 2. Obtain consent from patient or parent/ guardian if unable to give consent. Ensure that: ¨ Patient will be escorted home by responsible adult. ¨ Warn patient not to drive/ operate machinery, drink alcohol or make important decisions for 24 hours post-op. 3. Check patient has had only a light meal in previous 4 hours. 4. Perform the procedure only if adequate emergency apparatus / trained nursing staff present . Always insist on an escort being present throughout. 5. Check pre-op BP and pulse oximeter readings. Administer oxygen via nasal cannulae at 4L/min. 6. Lie patient horizontally. Insert a 14G or 16G intravenous catheter in the back of the hand and check patency. Secure firmly with tape. 7. Titrate the Midazolam carefully in 1ml aliquots up to a maximum dose of 10mg for a 70kg adult, waiting for each dose to have its effect. Patients should ideally be drowsy but will respond to command. 8. Be very caution administering Midazolam to the elderly (max dose 1-2mg usually) since they can suffer profound respiratory depression even with very small doses. 9. Administer the local anaesthetic and perform the required procedure, monitoring the patients’ vital signs at regular intervals. Allow the patient to recover in the recovery area. Allow home when you and the nursing staff are happy.
NB Always have the Benzodiazepine antagonist Flumazenil (‘Anexate’) available for IV administration, if it proves necessary to reverse the sedation for any reason. Note however, that its duration of action is much shorter than that of the Benzodiazepines. Be familiar with its uses before it is required! |
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Used in conjunction with local anaesthesia for anxious patients and those with learning difficulties, who have relatively straightforward surgical problems. Contraindications include adverse reaction to the agent, unescorted patient and severe cardiorespiratory / psychiatric disease. Sedation should not be routinely administered to patients under the age of 16 or above 70 years of age. |
