Policy:
Owner:
Initiated:
Version:
Last Approval Date:
Reference:
1.0
Conscious Sedation
CNO, Anesthesia Department, Medical Staff
08/2010
2
8/2012
S. Smith, D. Duell, B. Martin, Clinical Nursing Skills, Basic to Advanced Skills,
(8th ed) 2011. Statement on Safe Use of Propofol; Committee of Origin:
Ambulatory Surgical Care (Approved by the ASA House of Delegates on October
27, 2004, and amended on October 21, 2009). Standards for Basic Anesthetic
Monitoring– Committee of Origin: Standards and Practice Parameters. (Approved
by the ASA House of Delegates on October 21, 1986, and last amended on
October 20, 2010 with an effective date of July 1, 2011.). Joint Commission
Standards (2012): PI.01.01.01, PC.03.01.01, PC.03.01.03, PC.03.01.05, PC
03.01.07
DEFINITIONS
1.1 Minimal Sedation:
Minimal Sedation (anxiolysis) is a drug-induced state in which patients respond normally
to verbal commands. Although cognitive function and coordination may be impaired,
ventilatory and cardiovascular functions are unaffected. Medication used for this purpose
and for sedation of mechanically ventilated patients or for urgent/emergent endotracheal
intubation is covered by separate protocols.
1.2 Moderate Sedation/Analgesia:
Moderate Sedation/Analgesia (conscious sedation) is defined as a drug-induced
depression of consciousness during which patients respond purposefully to verbal
commands, either alone or accompanied by light tactile stimulation. No
interventions are required to maintain a patient airway and spontaneous ventilation
is adequate. Cardiovascular function is usually maintained.
1.3 Deep Sedation/Analgesia:
Deep Sedation/Analgesia is a drug-induced depression of consciousness during
which patients can’t be easily aroused but respond purposefully following repeated
or painful stimulation. The ability to independently maintain ventilatory function
may be impaired. Patients may require assistance to maintain a patent airway, and
spontaneous ventilation may be inadequate. Cardiovascular function is usually
maintained. Deep sedation and anesthesia is restricted to use by an anesthesia provider.
1.4 Anesthesia:
Consists of general anesthesia and spinal or major regional anesthesia. It does not include
local anesthesia. General anesthesia is a drug-induced loss of consciousness during which
patients are not arousable, even by painful stimulation. The ability to independently
maintain ventilatory function if often impaired. Patients often require assistance in
maintaining a patent airway, and positive pressure ventilation may be required because of
depressed spontaneous ventilation or drug-induced depression of neuromuscular function.
Cardiovascular function may be impaired.
2.0
POLICY
2.1
The Chairman of Anesthesia assists in establishing guidelines to insure that conscious
sedation is administered in a safe and appropriate manner consistent with the patient’s
needs.
2.2 This policy applies to all departments administering conscious sedation.
2.3
Conscious sedation will only be administered in appropriate settings where facilities,
competent personnel and all necessary equipment is available for any foreseeable emergency
situation.
2.3.1 The administration of Propofol and monitoring of patients receiving Propofol is
restricted to the following departments and associated staff: Department
of Anesthesia (Physicians, CRNAs); Emergency Department (Physicians, MidLevel Providers, RNs); Intensive Care (Physicians, Mid-Level Providers, RNs); and
in clinical settings where the patient is intubated and receiving a continuous
infusion of Propofol (i.e., ICU, ED, PACU, or during the transport of a patient to
another setting)
2.4 Only staff that have successfully completed the Conscious Sedation Competency
requirements and meet the ongoing competency requirements will administer conscious
sedation.
2.4.1
Physician requirements (non-anesthesiologists)
Non-anesthesiologists physicians who administer conscious sedation/ analgesia must
be ACLS certified and meet the credentialing requirements of the medical staff
required for conscious sedation administration.
2.4.2
Nursing requirements:
2.3.2.1 Maintain BLS and ACLS certification. PALS is required for those
administering pediatric conscious sedation.
2.3.2.2 Knowledge of cardiac rhythm identification
2.3.2.3 Completion of annual conscious sedation competency
2.5 The physician/LIP administering conscious sedation is responsible for obtaining consent.
2.6 Consult the Anesthesia Department for those patients who are at risk for losing protective
reflexes during conscious sedation.
2.7 Patients classified as ASA IV or ASA V should be considered for Monitored Anesthesia
Care (MAC) rather than conscious sedation if a procedure is to be performed outside the
Intensive Care Unit or the Emergency Department.
3.0
PROCEDURE:
3.1
Propofol Specifics 1
Due to the potential for rapid, profound changes in sedative/anesthetic depth and the lack
of antagonist medications, agents such as propofol require special attention. Even if
moderate sedation is intended, patients receiving propofol should receive care consistent
with that required for deep sedation.
3.2
3.1.1
Procedural Propofol should be administered only by persons trained in the
administration of general anesthesia, who are not involved in the conduct
of the surgical/diagnostic procedure.
3.1.2
Continuous infusion of Propofol for the intubated patient requires continuous
hemodynamic monitoring by competent staff trained in deep conscious sedation.
3.1.3
During the administration of Propofol, patients should be monitored without
interruption to assess level of consciousness, and to identify early signs of
hypotension, bradycardia, apnea, airway obstruction and/or oxygen desaturation.
3.1.4
Monitoring for the presence of exhaled carbon dioxide should be utilized (unless
invalidated by the nature of the patient, procedure or equipment) because
movement of the chest will not dependably identify airway obstruction or apnea.
Conscious Sedation Requirements:
3.2.1
Equipment:
All equipment will be available and in demonstrated working capacity. The
Bio-medical equipment used shall be inventoried and maintained on a regularly
scheduled basis by the hospital’s Biomedical Engineering Department.
3.2.1.1 A self-inflating positive-pressure oxygen delivery system must be
immediately available. Various size and age appropriate bag and mask
sizes must be available in those areas which care for pediatric patients.
3.2.1.2 Oxygen source, nasal cannula and a non-rebreathing mask
3.2.1.3 Suction source (portable or wall)
3.2.1.4 An emergency cart which should include the necessary age appropriate
equipment and drugs to treat any emergency ranging from apnea to
cardiac arrest.
3.2.1.5 A pulse oximeter
3.2.1.6 A blood pressure monitor with continuous capability
3.2.1.7 Cardiac monitor
3.2.1.8 During moderate or deep sedation, monitoring for the presence of exhaled
carbon dioxide should be utilized (unless invalidated by the nature of the
patient, procedure or equipment) because movement of the chest will not
dependably identify airway obstruction or apnea.2
1
Statement on Safe Use of Propofol; Committee of Origin: Ambulatory Surgical Care (Approved by the ASA House of
Delegates on October 27, 2004, and amended on October 21, 2009)
2
Standards for Basic Anesthetic Monitoring – Committee of Origin: Standards and Practice Parameters. (Approved by the
ASA House of Delegates on October 21, 1986, and last amended on October 20, 2010 with an effective date of July 1, 2011.)
3.3 Pre-Procedure
3.3.1
The physician administering conscious sedation will perform a pre-procedure health
evaluation and physical assessment and will complete documentation on the Short
History and Physical Form or department and/or physician specific forms.
3.3.2 The procedural RN will perform a pre-procedure assessment and will document the
following:
3.3.2.1
Baseline Vital Signs (blood pressure, pulse, respiratory rate, color of nail
beds, skin color and temperature)
3.3.2.2 Baseline level of consciousness
3.3.2.3 Baseline oxygen saturation
3.3.2.4 Drug allergies
3.3.2.5 Medication history
3.3.2.6 Relevant medical/surgical history
3.3.2.7 NPO status
3.3.2.8 Ability of the patient to communicate
3.3.2.9 Baseline EKG strip
3.3.2.10 Weight in kilograms
3.3.2.11 Pain Assessment
3.3.3 Determination of Pregnancy status is required in all females.
3.3.3.1
3.3.3.2
Obtain LMP and applicable gynecologic history.
Based on the information obtained in 3.3.3.1 pregnancy a test will be
performed at the physician’s discretion.
3.3.4 Verify informed consent has been obtained and is completed.
3.3.5 Establish IV access or establish patency of an existing IV in all patients undergoing
conscious sedation (even in oral sedation cases).
3.3.6
Initiate discharge teaching prior to sedation.
3.4 Intra Procedure
3.4.1
“Time-Out” verification shall be performed prior to the start of medication.
3.4.2
Continuous oxygen via nasal cannula.
3.4.3
Blood pressure, pulse and respirations every 5 minutes or more frequent if needed.
3.4.4
Continuously monitor cardiac rate and rhythm, pulse oximetry and ETCO2 (when
used)
3.4.5
Assess patient’s ability to manage secretions, suction as necessary
3.4.6
Observe for patient’s response to medication and for physiological and
psychological changes. Report to MD any changes in level of consciousness,
restlessness, cyanosis, pallor, flushing, allergic reaction, N/V.
3.4.7
Document administration time of all medications and agents administered.
Continually assess the patient’s response to medications and procedure.
3.5 Immediate Post Procedure (or after the last dose of medication was given)
3.5.1
The RN will remain with the patient until Discharge or Transfer criteria is met.
3.5.2
Assess patient’s pain level, level of sedation and tolerance of procedure.
3.5.3
Vital signs will be obtained a minimum of q15x3 (initial set, 15 min later and 30
minutes after the first set) or more frequently if necessary. Pulse oximetry will be
monitored accordingly or until pre-procedure level is reached. If a reversal agent
is required the patient must be monitored for no less than 60 minutes.
3.5.4
Prior to discontinuation of the monitoring, the patient’s vital signs must return to
within 20% of baseline for 2 consecutive readings. The patient must achieve an
Aldrete score of 8 or return to baseline assessment if initially impaired.
3.5.5
Patients must meet Discharge/Transfer criteria stated below, prior to leaving the
Post-procedure area.
3.6 Inpatient Transfer and Discharge to Home Criteria
3.6.1
3.6.2
Patients who meet the following criteria may be transported by non-licensed
personnel to the receiving department after report has been given to the
accepting Nurse.
3.6.1.1
Vital signs are stable, within 20% of baseline for 2 consecutive readings.
3.6.1.2
Level of consciousness returned to pre-procedure level.
3.6.1.3
Aldrete score is 8 or at pre-procedure baseline.
3.6.1.4
Patient and/or responsible party can verbalize an understanding of postprocedure instructions.
3.6.1.5
Pain comfort goal is met with or without medications.
3.6.1.6
If applicable, bleeding is controlled.
Other Discharge Criteria to be met by Out-Patients
3.6.2.1
Discharge should be no sooner than 30 minutes after administration of
and/or no sooner than one hour after administration of reversal
medication.
3.6.2.2
Patient will tolerate fluids with minimal nausea and without vomiting.
3.6.2.3
Patient will be able to ambulate to the level he/she did pre-procedure and
the IV will be removed following ambulation.
3.6.2.4
Discharge instructions for conscious sedation and post procedure
instructions will be reviewed. Understanding will be demonstrated by
the patient and/or responsible party and their signature will be obtained.
4.0
3.6.2.5
Transportation home will be verified.
3.6.2.6
Patient should have family, significant other, or friends available to
observe and/or assist at home for the first 24 hours.
DOCUMENTATION
4.1
The Conscious Sedation Flow sheet will be completed.
(Exception: Some departments (e.g., Interventional Radiology, Endoscopy and others
will utilize their individual flow sheets. It has been established that these flow sheets
meet minimum documentation requirements as outlined by this policy- see individual
units for those flow sheets).
4.2
Post-procedure report will be given to a licensed professional on all patients returning or
relocating to another nursing setting.
4.3
The Discharge Instructions will be reviewed with the patient and/or their representative
and all signatures obtained.
Attachments:



Conscious Sedation Flowsheet
Medication Reference Sheet
Moderate Sedation Monitoring - Data Collection Form
Conscious Sedation Flow sheet
(developed 2/08: Revised 3/10, 7/12)
Date:_________________MD:_________________________ RN:____________________________ Other:___________________________
Last PO intake: food _______________________ liquids________________________ Weight:_____________ LMP:___________________
Consent for procedure signed [ ] Consent for conscious sedation signed [ ] Equipment checked, emergency equipment available [ ]
Ride Home verified [ ] Name: _________________________________________ Phone: ___________________________________________
Medications and last dose: or [ ] see medication reconciliation sheet or [ ]see MAR
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Allergies and reaction: ______________________________________________________________________________________
IV site / solution ___________________________________________________________________________________________
Hx of Moderate Sedation and/or Anesthesia Reaction [ ] YES [ ] NO
ASA score: __________( see back of this page)
comments_________________________________________________________________________
Baseline VS: Time______
O2 Delivery
Procedure Information
BP _______
O2 sat (Room air) ____
[]Cannula _____L/ml
Procedure:_________________
HR _______
Aldrete score:_________
[]Mask _____L/ml
Start time:________
RR _______
[]Vent
End time:________
Time out: Correct patient /procedure/site/laterality verified. Time:_______________________
Staff present:__________________________________________________________________
Medications / dose
Time
BP / HR / Resp
SpO2
Rhythm
Pain
Response/Assessment
Total meds: _____________________________________________________________________
Comments:
MD signature: (for meds given)
Aldrete Score
Activity: able to move, voluntarily or on
command
Moves 4 extremities
Moves 2 extremities
Moves 0 extremities
Corculation
BP+/- 20%
pre-sedation level
BP+/- 20-50%
BP+/- 50% or >
Oxygen saturation
Saturation >92%
Requires o2 to maintain SpO2 >92%
SpO2 is <92% with O2
Fully awake
Arousable
Failure to elicit response
Color is pink
Pale dusky
Frank cyanosis
Post Procedure (q15 min x 3 minimum, after last dose of meds)
Time
BP / HR /R
SpO2 Pain Aldrete
Comments
=2
=1
=0
=2
=1
=0
=2
=1
=0
=2
=1
=0
=2
=1
=0
D/C or transfer vital signs:
Report given to:
Time:
RN signature:
Z/patient care services/lori karols folder/forms & attachments/conscious sedation – common.ech.0097
Conscious sedation Flowsheet
page 2
POST PROCEDURE NOTE
Patients tolerance of procedure:
______________________________________________________________________________________
Procedure Results______________________________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________________
Specimen Removed:___________ _____________________________________________ [ ] Not applicable
Sent to lab: ________________________________________________________________ [ ] Not applicable
Estimated Blood Loss: _______________________________________________________ [ ] Not applicable
Condition:
__________________________________________________________________________________


Monitoring may be discontinued and the patient may be discharged to home or appropriate unit
when the Aldrete score is at least 8 or upon a specific physician’s order.
Monitoring may be discontinued when the Aldrete score is at least 8 or upon a specific physician’s
order.
Please call Dr.
for further orders or for discharge to home
or other unit.
Nursing notes: [ ] No comments necessary
_______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
________________________________________________________________
IV D'C'd [ ] dressing applied [ ]
Discharged via [ ] wheelchair [ ] ambulatory
Accompanied by:_________________________________________________________
Z/patient care services/lori karols folder/forms & attachments/conscious sedation – common.ech.0098
Patient label
Moderate Sedation Monitoring - Data Collection Form
Please complete for ALL moderate sedation charts and forward to the
Quality/Performance Improvement Department by the 5th of the following month.
1. Please check department (All departments will do 10 charts per month
plus all adverse events)
 Endoscopy
 Radiology
 ADS
 Pain Management 
ED
 ICU
2.
Date: _________________
3. Physician Name _______________________
4.
Procedure: ______________________ 5. Screener: _______________________
6. Please check all moderate sedation charts for documentation of the
following.
 Consent for procedure and anesthesia obtained
 Pre-procedure assessment completed
 Pre-induction re-evaluation completed (re-evaluation time, BP, pulse, pulse ox)
 Vital signs Q5 min during procedure
 Discharge vital signs
__________ Procedure start time (time instrumentation contacts patient)
__________ Procedure end time (time instrumentation contacts patient)
7. Adverse Events:
 Unplanned Critical Care or hospital admission not due to procedure findings
 Reversal agent used (please note agent) ________________________________
 Pre-op unplanned anesthesia consult
 Post-op unplanned anesthesia consult
 Ambu / Mechanical Ventilation
 Cardiopulmonary Arrest
 Assist ventilation required
 Allergic drug reaction
 Pre-procedure assessment not completed.
STOP HERE: FOR REVIEWER USE ONLY of unplanned Critical Care or hospital
admission not due to procedure findings or if Reversal agent used
Comments:
___________________
Reviewer Signature
__________________
Review Date
Z/patient care services/lori karols folder/forms & attachments/conscious sedation
Medication
Fentanyl
(Sublimaze)
Action
Onset/Duration
Narcotic
Onset: IV 1-3 min
Duration: 30-60
min
Usual ADULT
Dose
Procedural sedation, For
analgesia: 0.5 to 1.5 mcg/kg
IV; may repeat every 1 to 3
minutes to desired effect
Usual PEDIATRIC
Dose
For analgesia: 0.5 to 1 mcg/kg IV (up
to 50 mcg/dose); may repeat every 3
minutes to desired effect
Reversal
Agent
Considerations/
Side Effects
Naloxone
(Narcan)
Inject slowly over 3-5 min.
Rapid injection may cause
skeletal muscle and chest
wall rigidity, impaired
ventilation, Laryngospasm
To provide sedation for minor
procedures in children 1 to 3 years old,
the recommended dose is 2 to 3
micrograms/kilogram/dose, which may
be repeated 30 to 60 minutes
Side EffectsNausea/Vomiting, Confusion,
Dyspnea, Constipation,
Backache, Dizziness,
Headache, Tachyarrhythmia,
Muscle rigidity
Children 3 to 12 years of age should
receive 1 to 2 mcg/kg/dose
Older children should receive 0.5 to 1
mcg/kg/dose; these doses may be
repeated every 30 to 60 minutes as
needed
Meperidine
(Demerol)
Narcotic
Onset: IV 1-3 min
Duration: 30-60
min
Pre-medication for procedure:
50 to 100 mg IM/SC 30 to 90
min before start of anesthesia
Pre-medication for procedure: 1.1 to
2.2 mg/kg IM/SC up to adult dose 30 to
90 min before start of anesthesia
Naloxone
(Narcan)
Do not use in patients
receiving MAO inhibitors or
procarbazine (may cause
fatal reaction)
May have additive CNS
depression with
antihistamines, and
sedative/hypnotics
Side EffectsNausea/Vomiting,
Hypotension, Respiratory
Depression, Seizure,
Dizziness
Medication
Action
Onset/Duration
Usual ADULT Dose
Usual PEDIATRIC Dose
Reversal
Agent
Considerations/
Side Effects
Morphine
Narcotic
Onset: IV Rapid
Duration: 2-5hrs
Pre-medication for anesthetic
procedure: 5 to 15 mg IV
administered very slowly
Premedication for anesthetic
procedure: 0.05 to 0.1 mg/kg IV
administered very slowly; MAX 10 mg
per dose
Naloxone
(Narcan)
Geriatric patients are more
sensitive to the effects of
opioid analgesics and may
experience side effects and
respiratory complications
more frequently
Administer 2.5-15 mg over 5
min. Rapid administration may
lead to increased respiratory
depression, hypotension, and
circulatory collapse.
Respiratory depression is
increased when combined
with a benzodiazepine
Side Effects- Pruritis, Rash,
Backache, Nausea/Vomiting,
, Respiratory Depression,
Urinary retention,
Hypotension
Lorazepam
(Ativan)
Benzodia
zepine
Sedative
Onset:
IV 15-30 min
IM 30-60 min
PO 15-60 min
Duration:
6-8 hrs
IM: 50 mcg (0.05 mg)/kg 2 hr
before surgery (not to exceed
4 mg)
IV: 44 mcg (0.044 mg)/kg (not
to exceed 2 mg) 15-20 min
before surgery
IM (Children): 0.02-0.09 mg/kg/dose
IM (Infants): 0.02-0.09 mg/kg/dose
IV (Children): 0.02-0.09 mg/kg/dose;
may use smaller doses (0.01-0.03
mg/kg) and repeat q 20 min.
IV (Infants): 0.02-0.09 mg/kg/dose;
may use smaller doses (0.01-0.03
mg/kg) and repeat q 20 min
PO (Children): 0.02-0.09 mg/kg/dose
PO (Infants): 0.02-0.09 mg/kg/dose
Flumazanil
(Romazicon)
Administer IM doses deep
into muscle mass at least 2 hr
before surgery for optimum
effect
Prior to IV use, Lorazepam
injection should be diluted
with an equal volume of
compatible solution
Administer at a rate not to
exceed 2 mg/min or 0.05
mg/kg over 2-5 min. Rapid IV
administration may result in
apnea, hypotension,
bradycardia, or cardiac arrest.
Geriatric patients CNS
reactions are more sensitive
to these effects
Side Effects-Sedation,
Dizziness
Medication
Midazalam
(Versed)
Action
Sedative/
Amnesic
Onset/
Duration
Onset:
IV 1-5 min
IM 15 min
PO 10-15 min
PR 20-30 min
Nasal 3-5 min
Duration:
1-4 hr
Usual ADULT Dose
Usual PEDIATRIC Dose
Reversal
Agent
Considerations/
Side Effects
Healthy Adults below 60
years of age; 1 to 2.5 mg IV
titrated slowly (max injection
rate 1.25 mg/min); wait 2 or
more minutes to fully evaluate
the sedative effect;; a total
dose greater than 5 mg is not
usually necessary; patients will
require approximately 30%
less Midazalam if narcotic
premedication or other CNS
depressants are used
IV: 6 months to 5 years of age; initial
dose, 0.05 to 0.1 mg/kg IV over 2-3
minutes, wait an additional 2-3 minutes
to fully evaluate the sedative effect
before initiating a procedure or
repeating a dose; total dose up to 0.6
mg/kg may be necessary; total dose
usually does not exceed 6 mg; dose
must be reduced in patients
premedicated with opioid or other
sedative agents
6 to 12 years of age; initial dose,
0.025 to 0.05 mg/kg IV over 2-3
minutes; then wait an additional 2-3
minutes to fully evaluate the sedative
effect before initiating a procedure or
repeating a dose; total dose up to 0.4
mg/kg may be needed; total dose
usually does not exceed 10 mg; dose
must be reduced in patients
premedicated with opioid or other
sedative agents
12 to 16 years of age, 1 to 2.5 mg IV
titrated slowly (max infusion rate 1.25
mg/min); wait 2 or more minutes before
titrating to fully evaluate the sedative
effect; wait an additional 2 or more
minutes after each increment to fully
evaluate the sedative effect; some
patients in this age range will require
higher than recommended adult doses;
total dose usually does not exceed 10
mg; dose must be reduced in patients
premedicated with opioid or other
sedatives
IM 0.1 to 0.15 mg/kg (up to 0.5 mg/kg
IM for more anxious patients); total
dose usually does not exceed 10 mg;
When combined with an opioid, reduce
dose of both agents
ORAL : 0.25 to 1 mg/kg ORALLY; max
dose 20 mg
INTRA-NASAL: 0.2 to 0.6 mg/kg
RECTAL: 0.25 to 0.5 mg/kg
Flumazanil
(Romazicon)
Titrate, if necessary, using
small increments to the
appropriate level of sedation;
wait an additional 2 or more
minutes after each increment
to fully evaluate the sedative
effect
Patients 60 years of age or
older, and debilitated or
chronically ill patients; 1 to
1.5 mg IV titrated slowly (max
injection rate 0.75 mg/min);
wait 2 or more minutes to
evaluate the sedative effect;
repeat to the appropriate level
of sedation (max infusion rate
0.5 mg/min); a total dose
greater than 3.5 mg is usually
not necessary; patients will
require approximately 50%
less midazolam than healthy
young patients if narcotic
premedication or other CNS
depressants are used
Side Effects- Apnea,
Respiratory depression,
Hiccoughs, Cough,
Nausea/Vomiting
Agitation, Somnolence
Medication
Propofol
(Diprivan)
Action
Anesthetic
Onset/
Duration
Usual ADULT Dose
Usual PEDIATRIC Dose
Onset:
40 sec
Duration:
3-10 min
Procedural sedation: 1 mg/kg
IV followed by 0.5 mg/kg every
3 to 5 min as needed for
sedation
Procedural sedation: 1 mg/kg IV
followed by 0.5 mg/kg every 3 to 5 min
as needed for sedation
Reversal
Agent
None
Considerations/
Side Effects
Contraindicated in patients
with egg, soy, or peanut
allergies
Assess respiratory status,
pulse, and blood pressure
continuously throughout
Propofol therapy.
Frequently causes apnea
lasting ³60 sec. Maintain
patent airway and adequate
ventilation.
Propofol should be used only
by individuals experienced in
endotracheal intubation, and
equipment for this procedure
should be readily available.
Side EffectsNausea/Vomiting, Involuntary
muscle movement,
Bradyarrythmia,
Hypertension, Priapism,
Anaphylaxis
Ketamine
(Ketalar)
Reversal of
Benzodiazepines
Onset: 1-2
min
Duration:
1-4 hrs
Usual dose of flumazenil is 0.2
milligram administered IV over
15 seconds. If adequate
sedation reversal does not
occur after an additional 45
seconds, this dose may be
repeated at 1-minute intervals,
as needed up to 4 times, to a
maximum total dose of 1
milligram.
Doses should be based on
patient response; most patients
respond to doses of 0.6 to 1
milligram
Usual dose of flumazenil in children 1
year or older is 0.01 milligram/kilogram
(mg/kg; up to 0.2 mg) administered IV
over 15 seconds. If adequate
anesthesia reversal does not occur
after an additional 45 seconds, further
injections of 0.01 mg/kg may be
repeated at 1 min intervals, as needed
up to 4 times. The maximum total dose
is 0.05 mg/kg or 1 mg, whichever is
lower.
N/A
Should be administered as a
series of small injections and
not as a single bolus dose
Monitor for return of alertness,
reduction in sedation, the
ability to comprehend and
obey commands, and
improvements in time/space
orientation. Patients may
experience re-sedation and
respiratory depression
Side Effects- Diaphoresis,
dizziness, Headache,
Abnormal vision, Agitation,
Seizure
Medication
Action
Onset/
Duration
Usual ADULT Dose
Usual PEDIATRIC Dose
Flumazanil
(Romazicon)
Reversal of
Benzodiazepines
Onset: 1-2
min
Duration:
1-4 hrs
Usual dose of flumazenil is 0.2
milligram administered IV over
15 seconds. If adequate
sedation reversal does not
occur after an additional 45
seconds, this dose may be
repeated at 1-minute intervals,
as needed up to 4 times, to a
maximum total dose of 1
milligram.
Doses should be based on
patient response; most patients
respond to doses of 0.6 to 1
milligram
Usual dose of flumazenil in children 1
year or older is 0.01 milligram/kilogram
(mg/kg; up to 0.2 mg) administered IV
over 15 seconds. If adequate
anesthesia reversal does not occur
after an additional 45 seconds, further
injections of 0.01 mg/kg may be
repeated at 1 min intervals, as needed
up to 4 times. The maximum total dose
is 0.05 mg/kg or 1 mg, whichever is
lower.
N/A
Should be administered as a
series of small injections and
not as a single bolus dose
Monitor for return of alertness,
reduction in sedation, the
ability to comprehend and
obey commands, and
improvements in time/space
orientation. Patients may
experience re-sedation and
respiratory depression
Side Effects- Diaphoresis,
dizziness, Headache,
Abnormal vision, Agitation,
Seizure
Nalaxone
(Narcan)
Opiate
Antagonist
Onset:
IV 2-3min
Duration:
45180 min
Reversal of opiate activity, 0.1
to 0.2 mg IV, repeat every 2 to
3 min as needed to desired
degree of reversal; may repeat
dose within 1 to 2 hr depending
on amount and type of opioid
and time interval since last
opioid administration
(Newborn infants) 0.001 mg to 0.015
mg/kg IV/IM, doses may be repeated
as needed to maintain opiate reversal
(Older infants/children) 0.001 mg to
0.015 mg/kg
N/A
Observe for re-sedation
postoperative patients with
preexisting cardiac disease
risk pulmonary edema due to
a significant shift of blood
volume into the pulmonary
vascular bed
during labor; risk of severe
hypertensive episodes in
patients with mild to moderate
hypertension; monitor blood
pressures
IV/INTRAOSSEOUS/IM/SUBQ, doses
may be repeated as needed to
maintain opiate reversal
Reversal
Agent
Considerations/
Side Effects
Side Effects- V-Fib, V-tach,
Dyspnea Pulmonary Edema,
Hypertension