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Cardiology
Conscious Sedation Local Anesthetics, Sedatives, and Reversing Agents
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 80 slides
Overview
- Scope of this topic
Fundamentals
- Definition of moderate sedation
- Rationale for moderate sedation in the cath lab
- Cardiac catheterization laboratory during a case
- ASA continuum of sedation
- American Society of Anesthesiologists continuum of sedation
- Deep sedation and general anaesthesia in the cath lab
- Preprocedure assessment
- Preprocedural evaluation
- Fasting before elective catheterization
- Emerging evidence against routine fasting
- Medication management before the procedure
- Airway examination and anatomic assessment
- The Mallampati scale
- Preprocedure sequence
Monitoring of sedation
- ASA monitoring strategies
- Documentation and the designated monitor
- Monitoring level of consciousness
- Monitoring pulmonary ventilation
- Capnography and end-tidal carbon dioxide monitoring
- Normal capnogram waveform
- Evidence for capnography during sedation
- Monitoring oxygenation
- Fingertip pulse oximeter in use
- Haemodynamic monitoring during sedation
- The Aldrete score
- The Aldrete scoring system for sedation
- Emergency equipment and team preparedness
- ASA recommended emergency equipment for moderate sedation
Local anaesthesia
- Mechanism of local anaesthetic action
- Voltage-gated sodium channel alpha-subunit topology
- Lidocaine as the agent of choice
- Local anaesthetic cardiotoxicity
- Negative inotropy and bupivacaine
- Selected local anaesthetic agents
- Addition of a vasoconstrictor
- Lidocaine with epinephrine multiple-dose vial
- Pharmacological trade-off of vasoconstrictors
Sedation and analgesia
- General approach to sedation and analgesia
- Risks of combining a sedative with an opioid
- Dexmedetomidine in the 2018 ASA guidelines
- Antihistamines as preprocedural sedatives
- Diphenhydramine in elderly patients
- Benzodiazepines: mechanism and dosing routes
- Midazolam injection vials
- Selected benzodiazepines for use in procedural sedation
- Altered clearance and choice of benzodiazepine
- Adverse effects of benzodiazepines
- Opiates for procedural analgesia
- Fentanyl injection ampoules
- Meperidine and renal insufficiency
- Selected opiates for use in procedural sedation
Special issues
- Reported local anaesthetic allergy
- Ester anaesthetics and PABA derivatives
- Safe agent choice with an allergy history
- Preservative-free single-dose lidocaine vial
- Pharmacological reversal of sedation and analgesia
- Naloxone
- Naloxone hydrochloride prefilled syringe
- Flumazenil
- Flumazenil injection ampoules
- Pharmacological reversal of sedation and analgesia
- Half-life mismatch after reversal
- Reversal agents by drug class
Future directions
- Properties of an ideal sedative agent
- Ketamine
- Dexmedetomidine
- Conclusions
- References
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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