Episode 65. Let’s Take A Timeout! Procedural Sedation with Quinn Cummings and Benjamin Jackson

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Picture based from : Godwin, Steven A. (2018). Procedural Sedation and Analgesia. Elsevier Inc. Chapter 4. p. 53.
Picture taken from : Godwin, Steven A. (2018). Procedural Sedation and Analgesia. Elsevier Inc. Chapter 4. p. 53.

Patanwala, A., Thomas, M., Casanova T., Thomas, R., (2012). “Pharmacists’ role in procedural
sedation and analgesia in the emergency department”. Am J Health-Syst Pharm. Vol69:1336-42. DOI 10.2146/ajhp110707

PROPOFOL

  • Effect: Sedation and amnesia but does not elicit analgesic properties
  • Initial Bolus Dosing (IV): 1 mg/kg
  • Titration: 0.5 mg/kg every 3-5 min as needed
  • Onset of Action IV: Fast  (30-60 seconds)
  • Duration of Action: Short (5-10 minutes)
  • Adverse Effect: Respiratory depression and hypotension

Ketamine

  • Effect: Unique procedural sedation agent, dissociative agent that creates a trance-like state and causes amnesia in patients, analgesic activity
  • Initial Bolus Dosing (IV): 1-2 mg/kg
  • Titration: 0.5 mg/kg every 5-10 min as needed
  • Onset of Action IV: Fast (30-40 s)
  • Duration of Action:  Long (60 min)
  • Adverse Effect: Dose-related increase in heart rate and blood pressure, increased inotropy causes increased myocardial oxygen demand

MIDAZOLAM

  • Effect:  Sedation, retograde amnesia
  • Initial Bolus Dosing (IV): 0.1 mg/kg
  • Titration: 0.1 mg/kg every 2 min as needed
  • Onset of Action IV: Fast (2-5 min)
  • Duration of Action: Short (30-80 min)
  • Adverse Effect: respiratory depression and hypotension

FENTANYL

  • Effect:  Reduction and control of pain
  • Initial Bolus Dosing (IV):  0.5-1.5 mcg/kg
  • Titration:   0.5-1.5 mcg/kg every 1-3 min as needed
  • Onset of Action IV: Rapid (1-2 min)
  • Duration of Action:  Short (30-60 min)
  • Adverse Effect:  Dose-dependent respiratory depression

ABOUT AUTHOR

Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

The Pharm So Hard Podcast is a show focused primarily on emergency medicine and hospital pharmacy related topics. To empower healthcare providers with the knowledge and skills they need to provide evidence-based, safe care for critically ill patients.

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