Podcast 876: Sedation Pearls

<p dir="ltr"><strong>Contributor: Travis Barlock MD</strong></p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <p dir="ltr">Common sedatives used in the Emergency Department and a few pearls for each.</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Propofol</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Type: Non-barbiturate sedative hypnotic agonizing GABA receptors.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Benefit: Quick on and quick off (duration of action is approximately 2-7 minutes), helpful for suspected neurologic injury so the patient can wake up and be re-evaluated. Also has the benefit of reducing intracranial pressure (ICP).</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Downsides: Hypotension, bradycardia, respiratory depression.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">What should you do if a patient is getting hypotensive on propofol?</p> </li> <ul> <li dir="ltr" aria-level="3"> <p dir="ltr" role="presentation">Do not stop the propofol. Start pressors. May have to reduce the propofol dose if delay in pressors.</p> </li> </ul> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Dexmedetomidine (Precedex)</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Type: Alpha 2 agonist - causes central sedation</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Uses: Patients are more alert and responsive and therefore can be on BiPAP instead of being intubated. Does not cause respiratory depression.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Downsides: Hypotension and Bradycardia.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Caution in using this for head injuries, its side effects can mask the Cushing reflex and make it more difficult to spot acute elevations in ICP and uncal herniation.</p> </li> </ul> <li dir="ltr" aria-level="1"> <p