Hassan Mohamed Ali Associate professor of anesthesia and pain management, Anesthesia department, Cairo University. MB.B.ch, M Sc, M.D, FCAI, DESA Meeqat General Hospital, Madinah Munawarah

2. Hassan Mohamed Ali
Associate professor of anesthesia and pain management, Anesthesia department, Cairo
University.
MB.B.ch, M Sc, M.D, FCAI, DESA
Meeqat General Hospital, Madinah Munawarah

6.  Definition :
 The use of medications to minimally depress the
level of consciousness in a patient while allowing
the patient to continually and independently
maintain a patent airway and respond to verbal
commands and/or gentle stimulation.

8.  1-glasgow coma scale
 2-The Ramsay scale
 3-Modified Ramsay Sedation Scale
 4-University of Michigan Sedation Scale
(UMSS)
 5-. The Dartmouth Operative Conditions
Scale (DOCS)

9. Score Characteristics
0 Awake and alert
1
Minimally sedated: tired/sleepy,
appropriate response to verbal
conversation and/or sound
2
Moderately sedated:
somnolent/sleeping, easily aroused
with light tactile stimulation or a simple
verbal command
3
Deeply sedated: deep sleep, arousable
only with significant physical
stimulation
4 Unarousable

10.  It is used for a variety of diagnostic and
surgical procedures especially:
 endoscopy
 closed reduction of fracture
 radiologic procedures

11.  Reassurance
 Explanation
 Drugs:
 Benzodiazepines
(Midazolam,lorazepam,diazepam)
 Narcotics (Pethidine,fentanyl,morphine…etc)
 Hypnotics (Chloral hydrate,propofol,
Barbiturates)
 Dexmedetomidine (precedex)
 ketamine

12.  Midazolam:
 Dose: 1 to 2.5 mg slow IV every 2 minutes
 Antidote: Flumazenil (Anexate)
 Fentanyl
 Dose:1g.kg-1
 Antidote: Naloxone (Narcain)

 N.B. :I.V, weight

13.  Environment:
• crush trolley
• airway equipment
• full monitoring
• alarming system
• Patient:
• consent
• History
• Examination: airway, vitals

14.  Equipment and monitoring:
 oxygen supply
 suction apparatus and catheter
 airway equipment's
 face mask
 oral or nasopharyngeal airways
 LMA
 resuscitation bag
 endotracheal tubes
 laryngoscopes
 resuscitative equipment and medications (crash
cart)

15.  Doctor or nurse beside the procedure all
the times
 O2 saturation
 Vital signs checked (BP, pulse, respiratory)
 Documentation

16.  Failure
 Pain
 Over sedation(delayed recovery)
 Airway obstruction
 Vomiting
 Hypotension
 Arrhythmia
 hypoxia

17.  ACLS
 ER
 ICU
 Anesthesia
 WELL TRAINED PERSONNEL
 Follow the policy

18.  Appropriate alertness (brain)
 Appropriate vital signs (heart)
 Oxygen saturation above 92%on room air(lung)
 Ambulation (if he/she ambulated before)(limbs)
 No nausea or vomiting (stomach)

19. 