The Propofol infusion should be performed throughout the procedure or until the procedure expert advises that there are less than 5 minutes remaining in the procedure. Then, at the discretion of the PST-RN or staff, the Propofol infusion may be discontinued. The Propofol infusion should be performed throughout the procedure or until the procedure expert advises that there are less than 5 minutes remaining in the procedure. Then, at the discretion of the PST RN or Propofol staff, the infusion may be stopped. The infusion may be stopped at that time at the discretion of the PST RN or staff.
The infusion may be stopped at the discretion of the PST RN or staff at that time. The last 50% of the total dose should be given before starting the procedure.
PATIENT SELECTION CRITERIA
Patients receiving oral pentobarbital must be observed in the recovery area and must meet discharge criteria or as directed by the anesthetist before the patient can be discharged home. At the discretion of the sedation-designated anesthetist, oral pentobarbital may be administered in exceptional situations, after proper documentation of the exceptional situation. Midazolam may be added if the patient fails to sedate after receiving the maximum dose of pentobarbital and fentanyl, only after approval by the sedation designated anesthesiologist.
Oral midazolam is not part of the sedation protocol and should not be administered except in exceptional situations at the discretion of the assigned sedation anesthesiologist. 2) "Rescue" with pentobarbital or ketamine or midazolam to complete a study when dexmedetomidine is used as the primary sedation drug is at the discretion of the anesthesiologist.
SCHEDULING AND SCREENING OF RADIOLOGICAL EXAMINATIONS THAT REQUIRE SEDATION
Prior to the time of MRI or CT scan scheduling, if the patient has a cardiac history, the results of the echocardiogram, chest x-ray, and EKG results should be available so that the procedural sedation nurse can include those results in the workup for the sedation designated anesthesiologist's review. The EKG, chest x-ray and/or echo can be waived if the attending physician documents in the medical record that the patient is not at risk for heart disease. All relevant consultations, studies and laboratory values should be attached to the patient workup if available.
If the need arises, an evaluation is made on a case-by-case basis and it is at the discretion of the anesthesiologist to consider nurse-administered procedural sedation for the procedure. Patients who do not meet the criteria for procedural sedation by nurses will be referred to the Anesthesia Department for further management. In addition, if necessary, the patient may receive an oral water-soluble contrast agent prior to sedation (based on the current agreed guideline between anesthesia and radiology).
The LIP and procedural sedation nurse (independently) should perform a physical assessment of the patient with emphasis on the respiratory, respiratory, and cardiovascular systems. The LIP and procedural sedation nurse independently reviews the electronic medical record for relevant medical information and clinical laboratory values and records this information on the Sedation Monitoring Record. The procedural sedation nurse takes the patient's vital signs UPON ARRIVAL in the procedural area and records them in the sedation.
The procedural sedation nurse consults with the anesthesiologist to review relevant assessment information and history taken from. The medication plan is identified and discussed by the anesthesiologist and the procedural sedation nurse. In the event of decreased oxygen saturation, the palliative care nurse will institute basic resuscitation techniques (eg, open airway, head repositioning, administration of oxygen via face mask or ambu bag, suction).
POST SEDATION RECOVERY AND DISCHARGE 1. Patient Recovery
Any patient who has had a history of rage for 30 minutes or more is referred to anesthesia for management of future imaging studies, or other alternative sedation medications may be considered. The family is informed of the adverse event and instructed to list this as an adverse event when the child's history is forwarded to any healthcare provider. The nurse caring for the patient describes the adverse event in the patient's medical record and documents it in the electronic documentation system.
If a patient is over 18 years old and may require admission to an internal medicine service, call the internal medicine triage officer. This is always on pager 5025. If the patient is over 18 years old and requires ICU care, the patient can be admitted under anesthesia in the surgical ICU. An RN will do that. escort all admitted patients back to the department after the procedure and a handover report will be given.
These orders must be co-signed by the doctor who provides the inpatient service for the patient.
SEDATION OF PEDIATRIC PATIENTS AT THE PEDIATRIC SPECIALTY CLINIC 1. Department of Anesthesia Fasting guidelines shall be followed on all patients
QUALITY IMPROVEMENT INDICATORS
All patients or carers will be called by telephone the next working day or on Monday (if the procedure took place on a Friday) and a post-sedation questionnaire will be completed by the procedural sedation team. Adverse reaction: Oxygen saturation less than 90% (or less than 5% of baseline) for more than 60 seconds that is unresponsive to oxygen blowing, position change, jaw thrust, oral airway, foreign body removal such as bronchoscope and requires positive bag mask ventilation for more then 5 minutes to reverse the situation. Blood Pressure: Systolic blood pressure is less than or greater than 30% of baseline and persists for 5 minutes. Pharmacological therapy is required to restore this, even after a fluid bolus of 20 ml/kg.
Respiratory rate: RR less than or greater than 30% of baseline or apnea (with loss of end-tidal C02) for more than 30 seconds that is not amenable to repositioning or jaw thrusting or airways oral breathing. IV problem: more than 3 attempts or mechanical IV problem identified that affected medication delivery (medication extravasation). Apfelbaum, J.L., et al., Practice guidelines for postanesthetic care: an updated report from the American Society of Anesthesiologists Task Force on Postanesthetic Care.
Cravero, J.P., et al., Incidence and nature of adverse events during pediatric propofol sedation/anesthesia for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Murphy, Standardizing care and monitoring for anesthesia or procedural sedation performed outside the operating room. Gaitan, B.D., et al., Sedation and analgesia in the cardiac electrophysiology laboratory: a national survey of electrophysiologists investigating the who, how, and why.
Cravero, Current status of procedural sedation for pediatric patients in non-operating room locations. Heuss, L.T., et al., Risk stratification and safe administration of propofol by registered nurses under the supervision of a gastroenterologist: a prospective observational study of more than 2000 cases. Hoffman, G.M., et al., Risk reduction in pediatric procedural sedation using the American Academy of Pediatrics/American Society of Anesthesiologists process model.
Annually read the information on sedation-related topics on the Anesthesia Procedural Sedation Website. It is preferable that at least pulse oximetry be used for monitoring before the procedure.
Measures to Prevention/Ameliorate Nephrotoxicity
Normally this can be achieved by oral administration of an additional 1-2 liters of fluid in the 24 hours prior to the contrast injection. Withhold metformin for 48 hours after the procedure and do not resume it until renal function has been reassessed and determined to be normal. In patients with risk factors for contrast-induced renal failure (see #2 above), administer acetylcysteine, 600 mg, orally twice daily on the day before and on the day of contrast administration (4 total doses). e.
Premedication
There are potential serious side effects for patients receiving gadolinium-based contrast agents who have impaired kidney function. There is a preference for 20-G or larger catheters/cannulas with flow rates of 3 ml/second or higher. All injections should be monitored during the first 10-15 seconds of injection to ensure that extravasation does not occur early.
The use of central venous catheters should be discouraged, although some larger bore catheters may be used in exceptional circumstances. Patients with abnormal circulation to limb to be injected (atherosclerosis, Raynaud's disease, venous thrombosis/insufficiency, previous radiation therapy, previous axillary surgery).
Treatment of contrast media reaction
Suggested Treatments for Adult Patients for Adverse Effects to Contrast Agents
Fasting guidelines apply to patients of all ages receiving anesthesia from the Department of Anesthesia, including monitored anesthesia care. Guidelines may need to be modified for patients with coexisting diseases or conditions that may affect gastric emptying or fluid volume [eg, pregnancy, obesity, diabetes, hiatal hernia, An infant should finish breastfeeding about 4 hours before the surgery/procedure or should receive clear fluids (eg, Pedialyte®) about 2-3 hours before the surgery/procedure.
2 Very sedated Is aroused by physical stimuli, but does not communicate or follow commands, can move spontaneously. If the patient is awake or wakes up easily by voice ("wake" means responding with voice or shaking head to a question or following commands), that is a SAS 4 (same as calm and appropriate - maybe even taking a nap). If more stimuli such as shaking are needed, but the patient eventually wakes up, that is SAS 3.
If the patient is awakened to stronger physical stimuli (may be noxious) but never awakens to the point of responding yes/no or following commands, it is a SAS 2. Assessment of sedation in ventilated ICU patients with the bispectral index and sedation -the agitation scale. Confirmation of the reliability of the Sedation-Agitation Scale in ICU nurses without prior experience in its use.
Validation of the Sedation-Agitation scale with the bispectral index and the visual analogue scale in adult ICU patients after cardiac surgery. Fasting guidelines: Patient/family are advised not to eat 8 hours before or to give formula/non-human milk 6 hours before or to give breast milk for 4 hours before the procedure. Light intensity activities: Slow walking, golf (motorized cart), swimming (slow pedaling), gardening or pruning, cycling (very light effort), vacuuming, and cardio (light stretching or warm-up).
