Moderate Sedation (RASS: Richmond-Agitation-Sedation-Scale)

Sedatives are common adjuncts for the treatment of anxiety and agitation

 

Sedation of agitated critically ill patients should be started only after providing adequate analgesia and treating reversible physiological causes. 

 

Sedation is indicated to relieve anxiety, to assist in ventilatory support and to treat agitation. 

 

What sedatives have you used in your clinical experience? What was the titration?

• fentanyl citrate: after surgery, with NS 1L with nausea injection 20cc/hr
• pethidine 1@ with ns 100, 20cc/hr
• lorazepam ( ativan): when the patient is irritable, or before CT or MRI test IVS
• diazepam: seizure, epilepsy, alcohol withdrawal syndrome, anxiety
• midazolam: rapid sedation of acutely agitated patients, short term use only, it produces unpredictable awakening and time to extubation when infusions continue longer than 48~72 hours

What should you monitor for patients on sedatives? What are some common side effects you should look out for?

• respiration 
• level of consciousness
• skin or mucosal color (pale because of low BP)
• BP, HR
• pulse oximetry
• ECG for arrhythmias

side effects: dizziness, nausea, vomiting, difficulty focus and thinking, blurred vision, impaired depth perception, slowered reaction, bradicardia.

 

What are the side effects of Analgesics withdrawal? How will you troubleshoot if your patient is experiencing withdrawal symptoms?

 

• watery eyes, runny nose and sneezing
• yawning and disturbed sleep
• hot and cold flushes, sweating and 'goosebumps'
• feeling anxious or irritable
• cravings for opioids
• nausea, vomiting, diarrhea and a lack of appetite
• tremor (shaking)

assess patient's symptoms and solve their problems. For example, if they are undergoing nausea,vomiting give them promethazine, if they are undergoing diarrhea, give  loperamide, ibuprofen for myalgia. 

What tools did you use to assess sedation level in your patients? Explain about the RASS Assessment and what the scores mean.