【正文】 hesiology. 2022。 of this dose ( mg/min) every 4 minutes up to a maximum of 3 repeat doses –?Sedation failure? rate of approximately 20% – At least 15 minutes would be required to reach ?sedation failure? decision Fospropofol Sedation Success during Colonoscopy Cohen LB. Alimentary Pharmacology amp。240110 Midazolam Highly lipophilic Onset of action in 1 to 2 minutes Offset: rapid redistribution T1/2= hrs Metabolism hepatic and renal routes Prolonged action in elderly, hepatic and renally impaired 65 – use half doses Midazolam wide range of midazolam blood levels associated with adequate sedation Alcoholics: decreased sensitivity to drug Elderly: greater depressant effects Stimulatory effects in some patients cytochrome P450 (CYP) 3A4 oxidases Diazepam longer halflife a greater chance of phlebitis has less amnestic properties initial bolus of to mg. Incremental doses of mg can be given in 3 to 4 minute intervals. Opioids Fentanyl – Synthetic opioid – Fast onset – 2550 mcg, total doses 200 mcg – Titrate to fort Meperidine – 50100 mg Hydromorphone Pharmacological Antagonists Flumazenil – For reversing benzodiazepines – Does not reverse respiratory depression – mg boluses up to 3 mg – Risk of resedation Naloxone – Central opioid antagonist – Short acting, renarcotization risk – 40100 mcg – Risk of pulmonary edema 2022 Continuum of Depth of Sedation Standards for procedural monitoring for minimal to moderate sedation Evaluation of Patients Undergoing Sedation History and physical exam Review of current medications and allergies Assessment of cardiopulmonary status Patient instruction – . NPO Sedationrelated risk factors Sedationrelated risk factors include: – significant medical conditions such as extremes of age, severe pulmonary, cardiac, renal or hepatic disease, pregnancy, – the abuse of drugs or alcohol – uncooperative patients – a potentially difficult airway for intubation. Monitoring Patients undergoing endoscopic procedures with moderate or deep sedation must have continuous monitoring before, during, and after the administration of sedatives. Standard monitoring – heart rate (ECG), blood pressure, respiratory rate, and oxygen saturation Monitoring for Sedation NursePatient interaction Sedation Scores – Ramsay, OAAS/S Monitors – Pulse oximetry – ET CO2 – Depth of sedation monitor: EEG based BIS, Sedline, AEP, Entropy Observer?s Assessment of Alertness/Sedation Scale (OAAS) Scores Descriptions 5 Responds readily to name spoken in normal tone 4 Lethargic response to name spoken in normal tone 3 Responds only after name is called loudly and/or repeatedly 2 Responds only after mild prodding or shaking 1 Responds only after painful trapezius squeeze 0 No response after painful trapezius squeeze Post procedural Management Postprocedural monitoring including obs