Guideines forSedation and Analgesia byNon-Anesthesiologists.ppt

Guidelines for Sedation and Analgesia by Non-AnesthesiologistsEBM article. 報告人:林至芃 Definitions Sedation, analgesia, anesthesia:continuum of states ranging from minimal sedation (anxiolysis) through general anesthesia Not apply to patients receiving general or major conduction anesthesia (e.g., spinal or epidural/caudal block) PURPOSE Allows patients to tolerate unpleasant procedures by relieving anxiety, discomfort, or pain Children and uncooperative adultsexpedite the conduct of procedures that are not particularly uncomfortable but that require that the patient not move 水能載舟亦能覆舟 sedation practices may result in cardiac or respiratory depression- must be rapidly recognized and appropriately managed - avoid the risk of hypoxic brain damage, cardiac arrest, or death inadequate sedation / analgesiaundue patient discomfort or patient injury because of lack of cooperation or adverse physiologic or psychological response to stress Patient Evaluation (1) abnormalities of the major organ systems (2) previous adverse experience with sedation/analgesia as well as regional and general anesthesia (3) drug allergies, current medications, and potential drug interactions (4) time and nature of last oral intake (5) history of tobacco, alcohol, or substance use or abuse Patient Evaluation focused PE, including vital signs, auscultation of the heart and lungs, and evaluation of the airway Pre-procedure lab test: underlying medical condition Pre-procedure Preparation Sedatives and analgesics- impair airway reflexes - in proportion to the degree of sedation-analgesia achieved Pre-procedure fasting decreases risks during moderate/ deep sedation When no fasting = target level of sedation should be modified / intubation?? not drink fluids or eat solid foods for a sufficient period of time to allow for gastric emptying before their procedure Monitoring Level of Consciousness Response to commands during procedures Spoken responses also provide an indication that the patients are b