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Procedural Sedation

Updated : December 19, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

remimazolam 

Induction:
5 mg IV over 60 seconds
Patients with ASA-PS III/IV: 2.5-5 mg IV push over 1 minute, depending on patient condition.

Maintenance:
2.5 mg IV infusion administered over 15 seconds
1.25-2.5 mg IV push over 15 seconds for ASA-PS III/IV patients; at least 2 minutes must elapse before administering any supplemental dose.



secobarbital 

Indicated for Pre-procedure Sedation :

200 - 300

mg

orally

Prior to surgery



Dose Adjustments

Renal Impairment
lower dose recommended

Hepatic Impairment
lower dose recommended

etomidate 

0.1mg/kg intravenous bolus for 1-3 doses



meprobamate 

400mg orally before the surgery



dexmedetomidine 

Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.6 mcg/kg/hr Intravenous titrate to effect (generally 0.2 to 1 mcg/kg/hr)
fiberoptic intubation while Awake
Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.7 mcg/kg/hr Intravenous till endotracheal tube is secured



 

etomidate 

0.1-0.4 mg/kg intravenous bolus once



meprobamate 

200mg orally before the surgery



phenobarbital 

Before the procedure, administer 1 to 3 mg/kg Intramuscularly, intravenously, or orally for 1 to 1.5 hours



phenobarbital 

2mg/kg orally thrice a day



pentobarbital 

2 to 6 mg/kg Intramuscular, OR
1 to 3 mg/kg Intravenous
Should not exceed more than 100 mg



dexmedetomidine 

Less than 1 month: Safety & efficacy were not established
Sedation is initiated during non-invasive procedures
1 month to less than 2 yrs: 1.5 mcg/kg intravenous loading infusion; infuse for 10 minutes
2 yrs to less than 18 yrs: 2 mcg/kg intravenous loading infusion; infuse for 10 minutes
if clinically indicated, Consider lowering dose
Sedation should be maintained throughout non-invasive procedures
1 month to less than 18 yrs: 1.5 mcg/kg/hr intravenous initially; titrate inorder to achieve a desired clinical effect within a dose range of about 0.5 to 1.5 mcg/kg/hr



chloral hydrate 

Take a dose of 50 to 75 mg/kg orally, 30 to 60 min prior to procedure and this may be repeated in half an hour, if required
Dose should not be more than 1 g in infants and 2 g in children



 

midazolam 

20 - 50

mcg/kg

Solution

Intramuscular (IM)



dexmedetomidine 

Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.6 mcg/kg/hr Intravenous titrate to effect (generally 0.2 to 1 mcg/kg/hr)
fiberoptic intubation while Awake
Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.7 mcg/kg/hr Intravenous till endotracheal tube is secured



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References

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Procedural Sedation

Updated : December 19, 2022




remimazolam 

Induction:
5 mg IV over 60 seconds
Patients with ASA-PS III/IV: 2.5-5 mg IV push over 1 minute, depending on patient condition.

Maintenance:
2.5 mg IV infusion administered over 15 seconds
1.25-2.5 mg IV push over 15 seconds for ASA-PS III/IV patients; at least 2 minutes must elapse before administering any supplemental dose.



secobarbital 

Indicated for Pre-procedure Sedation :

200 - 300

mg

orally

Prior to surgery



Dose Adjustments

Renal Impairment
lower dose recommended

Hepatic Impairment
lower dose recommended

etomidate 

0.1mg/kg intravenous bolus for 1-3 doses



meprobamate 

400mg orally before the surgery



dexmedetomidine 

Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.6 mcg/kg/hr Intravenous titrate to effect (generally 0.2 to 1 mcg/kg/hr)
fiberoptic intubation while Awake
Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.7 mcg/kg/hr Intravenous till endotracheal tube is secured



etomidate 

0.1-0.4 mg/kg intravenous bolus once



meprobamate 

200mg orally before the surgery



phenobarbital 

Before the procedure, administer 1 to 3 mg/kg Intramuscularly, intravenously, or orally for 1 to 1.5 hours



phenobarbital 

2mg/kg orally thrice a day



pentobarbital 

2 to 6 mg/kg Intramuscular, OR
1 to 3 mg/kg Intravenous
Should not exceed more than 100 mg



dexmedetomidine 

Less than 1 month: Safety & efficacy were not established
Sedation is initiated during non-invasive procedures
1 month to less than 2 yrs: 1.5 mcg/kg intravenous loading infusion; infuse for 10 minutes
2 yrs to less than 18 yrs: 2 mcg/kg intravenous loading infusion; infuse for 10 minutes
if clinically indicated, Consider lowering dose
Sedation should be maintained throughout non-invasive procedures
1 month to less than 18 yrs: 1.5 mcg/kg/hr intravenous initially; titrate inorder to achieve a desired clinical effect within a dose range of about 0.5 to 1.5 mcg/kg/hr



chloral hydrate 

Take a dose of 50 to 75 mg/kg orally, 30 to 60 min prior to procedure and this may be repeated in half an hour, if required
Dose should not be more than 1 g in infants and 2 g in children



midazolam 

20 - 50

mcg/kg

Solution

Intramuscular (IM)



dexmedetomidine 

Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.6 mcg/kg/hr Intravenous titrate to effect (generally 0.2 to 1 mcg/kg/hr)
fiberoptic intubation while Awake
Loading dose: 1 mcg/kg Intravenous over 10 mins
Maintenance dose: 0.7 mcg/kg/hr Intravenous till endotracheal tube is secured



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