intravenousanaesthesia：靜脈麻醉(已修改)
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【正文】 Minimal and Moderate Sedation T. J. Gan, ., ., ., Li. Ac. Professor of Anesthesiology Vice Chair for Clinical Research Duke University Medical Center Content Why sedation? Current sedation practice Guidelines from professional society governing sedation practice Pharmacologic properties of sedatives Monitoring of patients undergoing sedation Clinical data on fospropofol for sedation Procedural Sedation Over 40 million procedures performed each year with moderate sedation About 23 millions endoscopic procedures performed annually Depending of the intended level of sedation, sedation is performed by trained nurses as well as anesthesia personnel Approximately twothirds of the endoscopic procedural sedation performed by non anesthesia personnel Importance of Sedation Relief of anxiety and fear Relief of disfort Increase patient pliance with screening/surveillance guidelines Enhance quality of the examination Minimize risks and physical injury to the patients Improve over experience and satisfaction Common Sedation Sites Colonoscopy Bronchoscopy Gastroscopy cardiac catheterization Office based outpatient surgery Emergency department Colonoscopy Safe Complications can occur Majority are cardiopulmonary plications, . over sedation, hypoventilation, aspiration, vasovagal CV plication rate: 24/1000 Patients at risk: elderly, morbidly obese Overview of agents used for minimal to moderate sedation 8 Characteristics of an Ideal Sedative ? Rapid onset of action allows rapid recovery after discontinuation1 ? Effective at providing adequate sedation with predictable dose response1,2 ? Easy to administer1,3 ? Lack of drug accumulation1 ? Few adverse effects13 ? Minimal adverse interactions with other drugs13 ? Predictable dose response2 ? Costeffective3 1Ostermann ME, et al. JAMA. 2022。283:14511459. 2Jacobi et al. Crit Care Med. 2022。30:119141. 3Dasta JF, et al. Pharmacother. 2022。26:798805. 4Nelson LE, et al. Anesthesiol. 2022。98:428436. Pharmacological Agents in MAC Hypnotics – Midazolam – Propofol – Methohexital – Ketamine – Nitrous oxide – Dexmedetomidine ? Analgesics – Opioids – Fentanyl – Meperidine – Hydromorphone – Morphine – Local anesthetics – NSAIDS Current Sedation Practice 99% of colonoscopies are performed with sedation – 75% with benzodiazepine and opioid – 25% with propofol and opioid 93% sedation with propofol performed with the presence of anesthesia professional Cohen et al. Am J Gastroenterol 2022。101:96774 Sedation Standard Drugs Used in Sedation Opioid and Benzodiazepine bination Benefits – 1 + 1 = 4 – Effective in 85% of patients – Reversal drugs available Challenges – Significant pharmacodynamic variability – Drug interactions – Potential for respiratory depression Cohen L. Gastroenterology 2022。133675701 Challenges Continued Challenges –Delayed recovery, not “clear
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