SEDATIVES IN
CRITICAL
AREAS
• Sedation is a sleep-like
state where patients are
generally unaware of
surroundings but may still
respond to external
stimuli.
• General anesthesia is a
form of a temporary
induced state of
unconsciousness in which
pain control and amnesia
are induced, and
patient’s airways may be
taken over and
monitored.
Sedative drugs should be titrated to meet patient-specific
objectives and to avoid morbidity mortality
Our target is to make patients
• Calm
• Comfortable
• Cooperative
• Communicative.
ASA classification of
Depth of sedation ( Modes )
Minimal Moderate Deep General
sedation sedation sedation anesthesia
(Anxiolysis ( Cnalgesia
) ( Conscious )
)
normal to Purposeful to Purposeful Unarousable
responsivn verbal verbal or following even with
ess tactile repeated or repeated or
stimuli painful painful
stimuli stimuli
Airway unaffected No Intervention Requied
intervention may be
required required
Spontaneo Unaffected Adequate Maybe Inadequate
us inadequate &
ventilation or compromise
compromise d
d
Sedation
scoring
Sedation scoring must be objective because guessing
the depth of sedation will not provide accurate or
consistent measurement.
The level of response determines the patient’s
numerical
score, indicating the level of sedation.
Regular reassessment may enable sedation to be
titrated for each patient to achieve an optimum
level of sedation
Zero is our
Preoperative
Assessment :
• Patient History : like any procedure
General , Medical , Surgical ,
previous sedation ).
• Physical examination :
General , blood pressure , SPo2 ,
Heart rate & airway assessment .
• Investigation :
labs , images , organs function
When is sedation
contraindicated ?
!
1. Allergy
2. Sever organ failure
3. Hemodynamic instability
4. Airway problems
5. Fasting
Techniques of
sedation
1. Oral Sedation:
• benzodiazepines (e.g., diazepam, lorazepam) or sedative-hypnotics (e.g.,
triazolam) are taken by mouth before the procedure.
• Start within 30 minutes to an hour.
• Easy to administer and doesn't require specialized equipment.
• BUT Takes longer to take effect & residual drowsiness after the procedure.
2. Intravenous (IV) Sedation:
• midazolam (a benzodiazepine) or propofol (a sedative-hypnotic) are
administered directly into the bloodstream
• Start typically within seconds to a few minutes.
• Provides deeper sedation, making it suitable for more invasive or longer
procedures.
• BUT Requires trained staff to administer and monitor the patient closely .
3. Intramuscular Sedation:
• ketamine, diazepam can be injected directly into the muscle.
• The onset is slower compared to IV sedation, typically within 10-15 minutes.
• Useful when IV access is difficult or when quick sedation is needed.
• BUT Less controlled than IV sedation and requires observation.
4. Nitrous Oxide (Laughing Gas):
• Administered via: A mask that fits over the nose,
• where the patient inhales a mixture of nitrous oxide & O2.
• Onset: Works rapidly, usually within a few minutes.
• Advantages: Fast-acting, easily reversible,
and does not cause prolonged drowsiness after the procedure.
• Mechanism : Nitrous oxide acts as an anxiolytic & mild sedative,
producing feelings of relaxation and euphoria
without causing the patient to lose consciousness.
• Disadvantages: May not be effective for all patients as COPD
or procedures if need a deeper level
Post procedure headache , nausea
5. Nasal Sedation :
• Benzo , opoioid ,
dexametomidine
• Within 10-15 mins
• Child , minimal invasion , avoid
iv
• BUT with Limited depth ,
nasal irritiation , respiratory
depression
• Good full mointoritng
• 6. Combination Sedation
(Polypharmacy):
• A combination of oral sedation, nitrous
oxide, and/or IV sedatives may be used
to achieve the desired level of sedation.
• Onset: Depends on the specific
combination used.
• Advantages: Can be customized to
meet the patient's needs for comfort
and anxiety reduction.
• Disadvantages: May require more
careful monitoring to ensure patient
safety.
Monitoring & Safety
Regardless of the sedation
method, continuous monitoring of
the patient’s vital signs (heart
rate, blood pressure, oxygen
levels, and respiratory function) is
essential to ensure safety during
the procedure.
In all cases, the goal of conscious
sedation is to create a relaxed,
comfortable state while
preserving the patient’s ability to
communicate and respond to
instructions.
COMPLICATIONS … MONITORING
1.Hypoxia , Airway obstruction & respiratpry depression …..SPO2
2.Aspiration
3.Hypotension ….Non invasve BP
4.Bradycardia …ECG
5.Tachycardia … ECG
6.Over sedation , panic ,Delirium & amnesia …. Keep your eyes
7.Neurological deficit …. Movements
8.Inadequate sedation
9.Nausea & vomiting .
10.Hospital admission
11.Cardiopulmonary arrest ( Death ).
ANTIDOTES
WHEN TO DISCHARGE ?!
1.Return to baseline mental status
2.Hemodynamic stable
3.Not alone and his company know
about our instrucations well
4.Motor !!
• Can walk unassisted
• If infant : can sit unattened
•THANK YOU
