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Sedation Guidelines

5

QuestionAnswer
Conscious Sedation - Statistics: Sedation was attempted in 18% of EEGs performed during the 4-year period. Ninety-one percent of the EEGs performed with sedation were completed successfully.
Conscious Sedation - Most Frequent Drug: Chloral Hydrate (CH).
Conscious Sedation - Conclusion: Sedation of children who are undergoing EEG examinations is effective and safe. Complications are infrequent.
Conscious Sedation - How do you reduce the need for sedation in children? Adequate preparation and by creating a less-threatening, child-friendly environment.
Conscious Sedation - Purposes: Allows application of recording electrodes to the scalp without causing excessive anxiety and without the need for restraints, it permits recordings with less muscle and movement artifact, and it allows the recording of the drowsy and asleep states.
Conscious Sedation - Which children are at increased risk for complications from sedation? Those who have an underlying problem with apnea or control of secretions or their airway - because pts lose the control of their body that keeps their airway open.
Conscious Sedation - What is JCAHO? The Joint Commission on Accreditation of Healthcare Organizations.
Conscious Sedation - What sedatives have been used in EEG? Chloral Hydrate, Fentanyl, Pentobarbital (Nembutal), Secobarbital (Seconal Sodium), Diazepam (Valium), Midazolam (Versed), and others.
Conscious Sedation - Can an EEG Technologist administer sedation? Only if registered, involved in annual continuing education courses on sedation, and administering oral under the supervision of a licensed physician.
Conscious Sedation - Why is CH the DOC? Safe, low therapeutic doses (80 mg/kg per body weight) and little effect on EEG at sedative levels.
Conscious Sedation - What are the effects of CH at toxic levels? Respiratory depression can occur.
Conscious Sedation - When are sedation deaths most likely to occur? When levels of consciousness or breathing are not being monitored.
Conscious Sedation - What does ASA stand for? American Society of Anesthesiologists.
Conscious Sedation - Why is conscious sedation so dangerous? Response may vary depending on factors such as speed and amount of drug absorption, underlying medical conditions, age of pt, recent sleep deprivation, and individual sensitivity to agents.
Conscious Sedation - What is to be done to prevent highly sensitive pts from dangerous effects? Monitor all pts through entire sedation process.
Conscious Sedation - What are the JCAHO Requirements? One standard of care, Pre-sedation health eval, Informed consent, Monitors and safety equipment, Standard forms and documentation, A person not performing test to monitor, Recovery protocols, Means to measure recovery.
Conscious Sedation - What are some examples of monitoring a sedated pt? BP, O2/Pulse monitor, Respiratory rate documented every 5 minutes for conscious and deep sedated pts.
Conscious Sedation - BP: No. A cuff may awaken the pt. Only take when awakening pt after procedure. CH is not known to effect this.
Conscious Sedation - What is the most sensitive monitor of brain O2 levels? EEG.
Conscious Sedation - What is the most accurate measurement in monitoring a pt during sedation? O2 saturation levels, as long as no supplemental O2 is being given to the pt.
Conscious Sedation - Pre-Sedation Health Evaluation: Should include hx and exam from past 30 days. An exam will be performed before the sedation by a physician, which should include age, weight, hx, allergies including drug, drug use, dosage, time route, and site of med admin.
Conscious Sedation - Informed Consent: Must follow local requirements of state and institution and provide a 24 h phone to number explain precautions and activity limitations. May or may not require signature. Drug info is available at pharmacy.
Conscious Sedation - Standard Monitors and Safety Equipment: Monitoring of respiratory is a must in pediatric sedation since this is the most common complication. Document tests of compentcy is a must.
Conscious Sedation - Documentation and Forms: Everyone in the facility must use the same standardized forms. How often a particular monitor is being monitored. Monitors include pulse, hr, bp, resp rate and EKG if not in EEG, conscious level and possible additional comments every 5-15 minutes.
Conscious Sedation - Second Person Required: AAP (American Academy of Pediatrics) and JCAHO state that someone not performing the test is required to watch all monitors throughout the procedure.
Conscious Sedation - Recovery and Discharge: Cardiovascular function and airway patancy stable, Pt is easily arousable and protective reflexes in tact, Pt can talk when appropriate, Pt can sit unaided (age app), If normally incapable of above, response level should be very close to normal.
Conscious Sedation - Performance Improvement: JCAHO requires some form of evaluation of improvement plan after sedation. This may be set facility-wide or you may develop your own.
Sedation is most effective in these groups of pts: Children and restless adults.
Created by: kmburg5840
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