Deep to Moderate sedation ppt for nursing

TEACHING ABOUT DEEP TO MODERATE SEDATION TO NURSING PROFESSIONALS

1. Deep to Moderate sedation Presentation by Prakash.G

2. Introduction Moderate to deep sedation refers to levels of sedation used in medical procedures to manage pain, anxiety, and discomfort. Here’s a breakdown of what each level entails, based on the American Society of Anesthesiologists (ASA) continuum of sedation: Degree of sedation are Light ,Moderate and Deep sedation .

3. Moderate to deep sedation Moderate to deep sedation refers to levels of sedation used in medical procedures to manage pain, anxiety, and discomfort. Here’s a breakdown of what each level entails, based on the American Society of Anesthesiologists (ASA) continuum of sedation: Deep Sedation: Responsiveness : Patient is not easily arousable but responds purposefully to repeated or painful stimulation. Airway : May require assistance in maintaining a patent airway. Spontaneous Ventilation : May be inadequate. Cardiovascular Function : Usually maintained.

4. Objectives of Moderate/Conscious Sedation Use the least amount of sedation to provide patient comfort. Maintain adequate sedation with minimal risk. Relieve anxiety and produce amnesia. Provide relief of pain an other noxious stimuli. Enhance patient cooperation. Maintain stable vital signs . Ensure a rapid recovery. To guard the patient’s safety and welfare To minimize physical discomfort, pain, or anxiety

5. WHO CAN ADMINISTER MODERATE SEDATION All moderate or deep sedation is ordered and supervised by a qualified anesthesiologist though light sedation may be given any resident doctor/treating physician trained in ACLS course. He/she assumes the responsibility of the patient until patient meets discharge criteria and/or returns to pre-sedation status.

6. Conscious sedation Deep (Unconscious ) Sedation 1 Mood altered Patient is unconscious 2. Patient Cooperative Patient unable to cooperative 3. Vital signs stable Vital signs are labile 4. Protective reflexes intact Protective reflexes obtunded 5. Local anesthesia provides analgesic Pain eliminated Centrally 6. Amnesia may be present Amnesia always present 7. Short recovery room stay Occasional prolonged recovery room or overnight admission required 8. Peri-operative complication infrequent Peri-operative complications are liable be more frequents 9. Uncooperative or mentally handicapped patient cannot always be management Useful in managing difficult or mentally handicapped patients.

7. QUALIFICATIONS OF PERSONNEL: TRAINING AND EDUCATION. COMPENTENCY IN AIRWAY MANAGEMENT MONITORING SKILLS EMERGENCY RESPONSE SUPERVISION AND COLLABORATION INSTITUTIONAL PROTOCOLS PATIENT SELCETION AND SCREENING DOCUMENTATION POST PROCEDURE CARE

8. ASA (American Society of Anesthesiology ) PHYSICAL STATUS CLASSIFICATION: CLASS 1  A normal, healthy patient with no organic, physiological, biochemical, or psychiatric disturbance CLASS 2 Mid-moderate systemic disturbance; may or may not be relatedto reason for surgery. (Examples: hypertension, diabetes mellitus) CLASS 3 Severe systemic disturbance. (Examples: heart disease, poorlycontrolled hypertension) CLASS 4 Life threatening systemic disturbance. (Examples: congestiveheart failure, persistent angina pectoris) CLASS 5 Life threatening systemic disturbance. (Examples: congestiveheart failure, persistent angina pectoris) Class E - Patient requires emergency procedure. (Example: appendectomy, D&C for uncontrolled bleeding )

9. Preparation of a Patient for Sedation PRE-SEDATION ASSESSMENT (Medical history, Allergic, Past reaction, current medication, Sleep apnoea, Airway assessment like Mallampati classification. NPO STATUS INFORMED CONSENT MEDICATION PREPARTION PREMEDICATION INSTRUCTION TO PATIENTS DOCUMENTATION TEAM PREPARATION EQUIPMENT REQUIRED.

10. EQUIPMENT NEEDED FOR SEDATIONS Oxygen and nasal Suction equipment Emergency crash cart with defibrillator Cardiac monitor (for patients with an underlying cardiovascular disease in which dysrhythmias are anticipated Pulse Oximetery Blood pressure monitor/manual recording facility  I/V supplies (fluids and transfusion sets) for ongoing I/V access Drug reversal agents for opioids and benzodiazepines Airway management tools and intubation equipment All patients must have an intravenous access secured prior to administrationof moderate or deep Sedation.

11. INTRA-PROCEDURE MONITORING POST PROCEDURE MONITORING AND DISCHARGE Patient is continually reassessed throughout the procedure. Vital signs (oxygen saturation, heart rate and blood pressure) are recorded every 5 minutes. Level of consciousness (Sedation Scale) is recorded every15 minutes. In patients with underlying cardiovascular disease ECG should also be monitored continuously. Verbal reassurance is given to patient frequently throughout the procedure. Untoward reactions or sudden/significant changes in monitoring parameters shall be immediately reported to the physician. Oxygen supplementation via mask/nasal prongs for all patients under sedation. Patient is continually reassessed throughout the procedure. Vital signs (oxygen saturation, heart rate and blood pressure) are recorded every 5 minutes. Level of consciousness (Sedation Scale) is recorded every15 minutes. In patients with underlying cardiovascular disease ECG should also be monitored continuously. Verbal reassurance is given to patient frequently throughout the procedure.  Untoward reactions or sudden/significant changes in monitoring parameters shall be immediately reported to the physician. Oxygen supplementation via mask/nasal prongs for all patients under sedation.

12. ALDRETE SCORING: PATIENT SIGN CRETERIA SCORE Consciousness Fully awake Arousable  Unresponsive 2 1 RESPIRATORY Breathe deeply and cough Dyspnea , hypoventilation Apneic 2 1 CIRCULATORY BP +/- 20 mm Hg of pre- anesthesia level BP > 20-50 mm Hg of preanesthesia level BP > 50 mm Hg of preanesthesia level 2 1 ACTIVITY Voluntary movement of all limbs to command Voluntary movement of two extremities to command Unable to move 2 1 OXYGEN SATURATION . 96-100 > 90 < 85 2 1

13. CIRCULATORY BP +/- 20 mm Hg of pre- anesthesia level BP > 20-50 mm Hg of preanesthesia level BP > 50 mm Hg of preanesthesia level 2 1

14. RESPIRATORY Breathe deeply and cough Dyspnea , hypoventilation Apneic 2 1

15. Consciousness Fully awake Arousable  Unresponsive 2 1

16. ACTIVITY Voluntary movement of all limbs to command Voluntary movement of two extremities to command Unable to move 2 1

17. OXYGEN SATURATION . 96-100 > 90 < 85 2 1

18. DISCHARGE CRETERIA COMPLETION OF ALDRETE SCORE Ability to ambulate consistent with baseline assessment; Ability to demonstrate a gag reflex; Ability to retain oral fluid, as appropriate to physician orders; Minimal pain; Ability of patient and home care provider to understand all home care instructions; Written discharge instructions given to patient/family; Concurrence with pre arrangements for safe transportation, including discharge to the care of a responsible adult. The patient may not drive self home.

19. Drugs used in our hospital Opioids Morphine and Fentanly antianxiety drugs like Midazolam Induction drugs are P PROPOFOL KETAMINE Etomidate

20. Injection used in ward setting Serance Lorazepam