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Why is IV sedation used alongside General Anaesthesia? watch

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    I'v seen that with some surgical procedures, oral or IV sedation is given to the patient before they're put under the general anaesthetic. What is the purpose of this? I understand this being done with local anaesthetic, but surely general puts them under anyway so what would be the purpose of sedation in this case?
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    Can't say I've ever seen someone be sedated before a general.

    What procedures were these?
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    Maybe if they're particularly anxious so they're sedated bit before they're taken to the anaesthetic room? This is coming from approximately nil knowledge of anaesthesia, just a thought.
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    (Original post by Etomidate)
    Can't say I've ever seen someone be sedated before a general.

    What procedures were these?
    I saw this done earlier this year with plastic surgery (patient was given sedation before general for liposculpture of the back and thighs), and i recently just watched a video on off pump CABG where the person describing it explained that "oral or IV sedation is given" before general but didn't explain why. It doesn't seem like sedation would serve any real purpose here before general so I dont know if I'm missing something
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    (Original post by Beska)
    Maybe if they're particularly anxious so they're sedated bit before they're taken to the anaesthetic room? This is coming from approximately nil knowledge of anaesthesia, just a thought.
    Ah, that would make sense. Still seems odd though
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    It's not routinely done these days. It does still happen in some circumstances for two major reasons:

    1) As Beska says, for anxiolysis prior to starting the anaesthetic. Mostly this is just in children and adults with learning difficulties (but not all of either of these groups), but for some very needle phobic or otherwise anxious adults it's still an option.

    2) In cardiac anaesthesia. All anaesthetic agents affect the cardiovascular system in some way, most commonly dropping blood pressure. Patients about to have heart surgery pretty much by definition already have a compromised cardiovascular system, and induction of anaesthesia can cause acute ischaemia, arrhythmias etc. Premed with something like temazepam reduces the dose of induction agent that is needed, and therefore, in conjunction with various other measures, theoretically minimises cardiovascular instability at induction.
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    (Original post by Helenia)
    It's not routinely done these days. It does still happen in some circumstances for two major reasons:

    1) As Beska says, for anxiolysis prior to starting the anaesthetic. Mostly this is just in children and adults with learning difficulties (but not all of either of these groups), but for some very needle phobic or otherwise anxious adults it's still an option.

    2) In cardiac anaesthesia. All anaesthetic agents affect the cardiovascular system in some way, most commonly dropping blood pressure. Patients about to have heart surgery pretty much by definition already have a compromised cardiovascular system, and induction of anaesthesia can cause acute ischaemia, arrhythmias etc. Premed with something like temazepam reduces the dose of induction agent that is needed, and therefore, in conjunction with various other measures, theoretically minimises cardiovascular instability at induction.
    Do they give the PO temazepam on the ward? Wouldn't it take a while to work?
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    (Original post by Awesome Genius)
    Do they give the PO temazepam on the ward? Wouldn't it take a while to work?
    In the hospital where I did cardiac anaesthesia, we wrote it up for 7am for the first patient on the list, (cardiac patients come in the night before, luxury!), so by the time they got to us at 8am they were nicely chilled. For the second patient we would call the ward and tell them to give it when the first one was coming off bypass, or when we gave the protamine for off-pump cases, from which point it took roughly an hour for closing, stabilisation and transfer to ICU, and we could return ready for the next one. As it was a routine part of the surgical pathway, it happened reasonably efficiently - I can imagine that on a general surgical ward it would be more challenging to get going.
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    (Original post by Helenia)
    In the hospital where I did cardiac anaesthesia, we wrote it up for 7am for the first patient on the list, (cardiac patients come in the night before, luxury!), so by the time they got to us at 8am they were nicely chilled. For the second patient we would call the ward and tell them to give it when the first one was coming off bypass, or when we gave the protamine for off-pump cases, from which point it took roughly an hour for closing, stabilisation and transfer to ICU, and we could return ready for the next one. As it was a routine part of the surgical pathway, it happened reasonably efficiently - I can imagine that on a general surgical ward it would be more challenging to get going.
    Ah right, that's cool. I've been on many wards where they pretty much ignore everything that's been written for inpatients awaiting surgery. Eg. 6am Na or K for NOFs. And then they just do the surgery anyway! Lol
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    (Original post by Helenia)
    It's not routinely done these days. It does still happen in some circumstances for two major reasons:

    1) As Beska says, for anxiolysis prior to starting the anaesthetic. Mostly this is just in children and adults with learning difficulties (but not all of either of these groups), but for some very needle phobic or otherwise anxious adults it's still an option.

    2) In cardiac anaesthesia. All anaesthetic agents affect the cardiovascular system in some way, most commonly dropping blood pressure. Patients about to have heart surgery pretty much by definition already have a compromised cardiovascular system, and induction of anaesthesia can cause acute ischaemia, arrhythmias etc. Premed with something like temazepam reduces the dose of induction agent that is needed, and therefore, in conjunction with various other measures, theoretically minimises cardiovascular instability at induction.
    Ah that explains it! Thanks for the info.
 
 
 
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