Reading materials for conscious sedation - Yale-New Haven Hospital

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Flumazenil(Romazicon®)Naloxone(Narcan®)IV 1-3 1-4 20kg: 0.2 mg over at least 15 seconds, mayrepeat after 45 seconds. Additional doses of0.2 mg may be given at 60 second intervals..Maximum cumulative dose 0.05 mg/kg or 1mg whichever is less.IV2-3 0.33-4 10mcg/kg over 30 seconds toreverse sedation.May repeat every 2-3 minutes.Larger doses may be required totreat overdose.0.2 mg over at least 15 seconds, mayrepeat in 45 seconds.Additional subsequent doses of 0.2mg may be given at 60 secondintervals. Total dose requiredgenerally not >1mg.20-40 mcg over 30 seconds toreverse sedation.May repeat every 2-3 minutes.Larger doses may be required to treatoverdose.REVERSAL AGENT FORBENZODIAZEPINESThe duration of action of flumazenil may be lessthan that of the benzodiazepine. Symptoms mayreappear requiring additional doses of flumazenil.Contraindicated in patients on chronicbenzodiazepines or tricyclic antidepressants (i.e.amitriptyline) in whom intubation is preferred toreversal with this agentUse caution in patients with seizure history.REVERSAL AGENT FOROPIATESMay be administered IM or SC if IVroute unavailable, but onset of effect isslower (i.e. 15 minutes). The durationof action of naloxone may be less thanthat of the opiate. Symptoms mayreappear requiring additional doses ofnaloxone.
UNRESTRICTED SEDATION AGENTSTypical Pediatric dose Typical Adult dose ConsiderationsA L T E R N A T I V E A G E N T SAgent Route Onset(min)Chloralhydrate(Noctec®)Diazepam(Valium®)Meperidine(Demerol®)PO 10-20Duration(hr)4-8 50-75 mg/kg, may repeatafter 30 min if sedationinadequate.TOTAL DOSE NOT TOEXCEED 120mg/kg or 1GRAM IN INFANTS and2 GRAMS IN CHILDRENIV 1-3 2-6 0.05-0.1mg/kg/dose, mayrepeat q30 min. Total dosegenerally not >5mgPR 10-30N/A 0.2-0.3mg/kgIV 5 2-4 Not used in pediatricpatientsMorphine IV 5 2-4 0.05-0.1mg/kg/dosemay repeat q10 minNot routinely given to adults For Children over 48 weeks postconceptional age to 3yrs of age and under 30 lbs.No at-home prescribing or administration beforearrival to institution for procedure.If sedation inadequate after 2 nd dose, then mustreschedule for future date. Caution! Effects arelong lasting! Consider alternative agent for futureprocedure.2-10mg/dose, may repeat q30min.Total dose generally not >30mgNot routinely given to adults25-150mg/dosemay repeat q5 min, rarely toexceed total dose of 300mgRecommended for one-timeintra-procedural use only2.5-10mg/dose, may repeatq10 min Total dose requiredgenerally not > 15mgMIDAZOLAM IS PREFERRED BENZODIAZEPINEDiazepam lasts longer than midazolam.Reversible with flumazenil.Administer slowly (i.e. over at least 2-3 min) toavoid respiratory depression/apnea. Re-sedationmay occur at 6-8 hours due to enterohepaticrecirculation and formation of active metabolite.Respiratory depression is potentiated whencombined with a narcotic.Reversible with naloxone. Contraindicated inpatients receiving MAOI (phenelzine,tranylcypromine, selegeline) within 14 days.Avoid in patients with renal failure or seizurehistory. Administer slowly (i.e. 10mg/min).Respiratory depression is potentiated whencombined with a benzodiazepine.Reversible with naloxone. Administer slowly toavoid respiratory depression or apnea. Use smallerdoses in debilitated, chronically ill, elderly, orpatients with decreased pulmonary or cardiovascularreserve. Respiratory depression ispotentiated when combined with abenzodiazepine.
Page 1: AdministrativePolicy Title:YALE-NEW
Page 6 and 7: If credentialed to provide deep sed
Page 8: APPENDICESAppendix A …………
Page 14 and 15: Pentobarbital(Nembutal®)IV 1 0.25
Page 17 and 18: APPENDIX BJCAHO Standards for Sedat
Page 19 and 20: APPENDIX DNPO GuidelinesSUMMARY OF
Page 21 and 22: APPENDIX FPediatric Sedation Equipm
Page 23 and 24: UNIT NO. APPENDIX GNAME:ADDRESS:DOB
Page 26 and 27: APPENDIX I - CONSENT FORMYALE-NEW H
Page 28 and 29: SUPPLEMENTSpecial Considerations fo
Page 30 and 31: POLICYAll moderate and deep sedatio
Page 32: Patients who must be considered for

Reading materials for conscious sedation - Yale-New Haven Hospital

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