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Sedation and Monitoring During Endoscopy

Purpose of Sedation. Allow patients to tolerate unpleasant procedures and relieve anxietyExpedite procedures that require an uncooperative patient to not move. Types of Sedation. Minimal Sedation

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Sedation and Monitoring During Endoscopy

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    1. Sedation and Monitoring During Endoscopy James W. Simmons

    2. Purpose of Sedation Allow patients to tolerate unpleasant procedures and relieve anxiety Expedite procedures that require an uncooperative patient to not move

    3. Types of Sedation Minimal Sedation Anxiolysis; patient responds normally to verbal commands. Cognitive function may be impaired but ventilatory and cardiovascular functions are not affected

    4. Types of Sedation Moderate Sedation(Conscious Sedation) patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained

    5. Types of Sedation Deep Sedation Patients cannot be easily aroused but can respond to repeated or painful stimulation. Ability to maintain ventilatory function may be impaired. May require assistance maintaining airway. Spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained

    6. Types of Sedation General Anesthesia Patients are not arousable. Ability to maintain ventilatory function is usually impaired. Often require assistance in maintaining a patent airway. Positive pressure ventilation may be required. Cardiovascular function may be impaired.

    7. Types of Sedation Sedation is a continuum Providers should be able to rescue patients from a deeper level of sedation than was originally intended Ex: If you administer moderate sedation you should be able to rescue someone from deep sedation

    8. Patient Evaluation There is some suggestive evidence that some pre-existing medical conditions may be related to adverse outcomes in patients who receive moderate or deep sedation Risks of complications are related to underlying conditions and the procedure being performed Experts agree that a preprocedure evaluation(H&P) increases the liklihood of satisfactory sedation and decreases the likelihood of adverse outcomes

    9. Patient Evaluation Recommended history items: Abnormalities of major organ systems Previous adverse outcome with sedation/anesthesia Drug allergies Current medications and potential interactions Time and nature of last PO intake H/O tobacco, Etoh, and substance abuse

    10. Patient Evaluation Recommended physical items: Cardiovascular heart and lungs Airway Habitus obesity, esp face and neck Head & Neck short neck, limited motion, tracheal deviation Mouth small opening(<3cm), edentulous, loose/bad teeth, no visible uvula, high arched palate Jaw micrognathia, retrognathia, trismus, malocclusion Mallampati Classification

    11. Mallampati Classification Class I-soft palate, fauces, uvula, tonsillar pillars Class II-soft palate, fauces, uvula Class III-soft palate, base of uvula Class IV-soft palate, no uvula

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