Anxiety, Phobia and Conscious Sedation Lecture 6 PDF

Contrast Media in Radiography and Medical Imaging RAD 244 Anxiety, Phobia and Conscious Sedation Lecture 6 1 Lecture Objectives To introduce the following concepts Anxiety, Phobia and Conscious Sedation...

Contrast Media in Radiography and Medical Imaging RAD 244 Anxiety, Phobia and Conscious Sedation Lecture 6 1 Lecture Objectives To introduce the following concepts Anxiety, Phobia and Conscious Sedation in Medical Imaging Dept. 1. Level of Sedation including Conscious Sedation 2. Conscious Sedation and Analgesics Drugs 3. Reversal agents 4. Equipment 2 Introduction Some radiological (e.g. Interventional) procedures can cause pain, anxiety, psychological and physical distress. These undesirable effects can be eased by using sedation and analgesia. The goal of sedation and analgesia is to improve the patients experience by minimising the negative effects of the procedure and to optimise patient outcome. * *Sedation, analgesia and anaesthesia in the radiology department, second edition. (rcr.ac.uk) 3 Definitions Anxiety: An abnormal and overwhelming sense of apprehension and fear often marked by physical signs (such as tension, sweating, and increased pulse rate), by doubt concerning the reality and nature of the threat, and by self-doubt about one's capacity to cope with it. Phobia: An exaggerated, usually inexplicable and illogical fear of a particular object, class of objects, or situation.* * Dictionary by Merriam-Webster: America's most-trusted online dictionary (merriam- webster.com) 4 Definitions Sedation: suppresses the central nervous system to a lesser degree, inhibiting both anxiety and creation of long term memories without resulting in unconsciousness. OR Sedation: Is a state of reduced irritability, agitation, or depressed consciousness to facilitate a medical or diagnostic procedure with the administration of sedative drugs. Conscious Sedation: An induced state of sedation characterized by a minimally depressed consciousness such that the patient is able to continuously and independently maintain a patent airway, retain protective reflexes, and remain responsive to verbal commands and physical stimulation. 5 Definitions Analgesic (painkiller): An agent producing diminished sensation to pain without loss of consciousness; a drug that is used to relieve pain. * * Analgesic | Definition of Analgesic by Merriam- Webster (merriam-webster.com) 6 Conscious Sedation and Analgesics Many of the conscious sedation drugs are common for children and adults, though dosages will vary. - Method of administered:  Adult (intravenously)  Paediatrics (Oral, Intranasal, Intramuscular, Intravenous and Rectal) 7  Level of Sedation Minimal Moderate Deep sedation General sedation sedation anesthesia (anxiolytic) 'conscious sedation' Responsiveness Normal Purposeful Purposeful Unarousable response to response to response to even to painful verbal verbal /tactile repeated/ stimuli stimulation stimulation painful stimuli Airway Unaffected No Intervention Intervention Intervention required may be usually required required Spontaneous Unaffected Adequate May be Frequently ventilation impaired; impaired; assistance may assistance may be required be required Cardiovascular Unaffected Usually Usually May be maintained maintained impaired 8 Categories of Agents as an analgesics Analgesics 1. Opiate (e.g. morphine, pethidine, codeine) 2. Non-opiate (e.g. Paracetamol, Nonsteroidal anti- inflammatory drugs “NSAIDs”) 3. Others (e.g. Nitrous oxide) Sedation, analgesia and anaesthesia in the radiology department, second edition. (rcr.ac.uk) 9 Categories of Agents Used for Conscious Sedation Sedatives: 1. Benzodiazepines (e.g. Midazolam, diazepam) 2. Barbiturates (replaced by benzodiazepines due to their side effects) 3. Propofol (an anaesthetic only drug due to its side effects) 4. Ketamine (an anaesthetic only drug due to its side effects) Sedation, analgesia and anaesthesia in the radiology department, second edition. (rcr.ac.uk) 10 Agents Used for Conscious Sedation- Benzodiazepines Benzodiazepines are a class of psychoactive drugs (are drugs or a chemical substance that changes nervous system function and results in alterations in perception, mood, consciousness, cognition, or behaviour) commonly known as minor tranquilizers. Uses: sedative, hypnotic, anxiolytic, anticonvulsant, and has muscle relaxant properties Benzodiazepines categorize : short, intermediary, or long-acting. E.g. Midazolam, diazepam (Valium) 11 Agents Used for Conscious Sedation- Barbiturates Barbiturates: are drugs that acts as a central nervous system depressant (effective as anxiolytics, hypnotics {Sleep induction}, and anticonvulsants). They have been replaced by benzodiazepines due to their side effects  Adverse effects: 1. physical and psychological addiction. 2. an overdose potential. 3. Barbiturates passes through the placenta to the fetes and is transmitted through breast milk. 12 Agents Used for Conscious Sedation- Propofol Propofol (intravenously): short-acting medication that results in a decreased level of consciousness and a lack of memory for events Uses: at the starting and maintenance of general anaesthesia, sedation for mechanically ventilated adults, and procedural sedation Side effects: irregular heart rate, low blood pressure, a burning sensation at the site of injection and the cessation of breathing, seizures, infections due to improper use, addiction. 13 Reversal agents Reversal agents are utilized to stabilize the effects of sedatives and analgesics. Safe sedation practices often minimize the need for reversal drugs. However, it's important to be prepared for their use and have a clear protocol in place. A clear reversal protocol should be developed and prominently displayed wherever sedation or analgesia is used * *Sedation, analgesia and anaesthesia in the radiology department, second edition. (rcr.ac.uk) 14 Importance of Reversal Protocol Reversal drugs may be rarely needed but are crucial for emergency situations. Helps sedation teams maintain readiness and proficiency. Enhances patient safety and minimizes risks associated with sedation and analgesia. 15  Reversal agents examples 1. Naloxone: Reverses the effects of opioids. Blocks respiratory depression and analgesic effects. Essential in managing opioid overdose and respiratory distress. 2. Flumazenil: Stabilizes sedative and amnesic effects of benzodiazepines. Rapidly reverses benzodiazepine-induced respiratory depression. Administered within two minutes of administration. 16  Key Points for Sedation and Analgesia In Medical Imaging Department 1. Safe and effective sedation and analgesia is an essential part of some radiological procedures. 2. An appropriately trained and credentialed team should administer sedation and analgesia. 3. Patients requiring sedation should undergo pre-procedure assessment and have a sedation plan. 17 Key Points for Sedation In Medical Imaging Department 4. A World Health Organization (WHO) checklist should be used for every sedated patient.? 5. Sedated patients should be appropriately monitored. 6. Resuscitation equipment and reversal agents should be readily available. 18 Key Points for Sedation In Medical Imaging Department 7. A properly staffed recovery area and formalised communication are essential for safe after-care and discharge. 8. All sedation related complications should be recorded. 9. Regular audit of practice should be performed. 10. A multi disciplined sedation committee should exist in each institution administering sedation and analgesia. 19 Equipment 1. Resuscitation/emergency cart with back-up power, defibrillator, equipment for intubation and ventilation immediately available with regular documented checks. 2. Oxygen supply - portable or fixed source with back-up supply. 3. Airway maintenance and oxygen delivery equipment- such as nasal cannula, face masks (including one capable of delivering 100% oxygen), oral airways, endotracheal tubes/supraglottic airways for example, laryngeal mask airways, laryngoscopes, Ambubag. 20 Equipment 4. Suction equipment (capable of producing continuous suction at 150 millimetre mercury [mmHg) and suction catheters, regularly checked and immediately available. 5. Monitoring equipment - pulse oximetry, blood pressure, heart rate, cardiac rhythm, respiratory rate. 6. Pressure related and position related injury prevention equipment (such as straps and gel pads 7. Magnetic resonance imaging (MRI) appropriate equipment for sedation in MRI scanner 21 Thank you! 22