EMCrit Podcast 151 – Procedural Sedation Part 3 with Jim Miner - a podcast by Scott D. Weingart, MD FCCM
from 2015-06-14T20:12:56
Today I am joined by James Miner, MD; chief of emergency medicine at Hennepin and an amazing, prolific researcher on procedural sedation.
Some of Jim's Procedural Sedation Studies
* [cite source='pubmed']25441247[/cite]
* [cite source='pubmed']23701339[/cite]
* [cite source='pubmed']20624140[/cite]
* [cite source='pubmed']19845550[/cite]
* [cite source='pubmed']16997421[/cite]
* [cite source='pubmed']15692132[/cite]
Some of the Points on Jim's Method for Short Procedures in Stable Patients
* Pre-procedural analgesia rather than peri-procedural
* He uses preoxygenation and ETCO2
* In stable patietnts, he gives 1-1.5 mg/kg of propofol up front
* 30-90 sec retrograde amnesia
* Can do painful things as propofol is coming on, but not coming off
Are there patients who will need different dosing?
* The elderly may need less, especially if they have opioids on board
* Volume depleted patients will need less
* Thin patients will need more, obese patients will need less (if we dose by actual weight)
* (IBW + 1/3 of remaining weight) may be the better way to dose with the 1.5 mg/kg
The biggest mistakes
* People ignore how long it takes for the propofol to kick in, need to wait 60 sec before a 2nd dose
Cardioversion
* Jim (and I) uses Etomidate
Nasal CPAP for Procedural Sedation
* [cite source='pubmed']25455053[/cite]
Alfentanil for Procedural Sedation
Stay Tuned
Update
An article demonstrating that supplemental oxygen impairs pulse ox detection of hypoventilation (Chest 2004;126:552)
And an article on Fasting (Ann Emerg Med. 2014;63(2):247-58. PMID: 24438649)
Now on to the podcast...
Further episodes of EMCrit Podcast
Further podcasts by Scott D. Weingart, MD FCCM
Website of Scott D. Weingart, MD FCCM