It's interesting to note that ACEP has moved away from the term 'conscious
sedation' and replaced it with 'procedural sedation', in acceptance of the
fact that experienced emergency physicians can safely sedate patients to a
level deeper than one at which they remain responsive to verbal commands.
The distinction between this and general anaesthesia is not the
responsiveness, ie. conscious level, but the maintenance of protective
airway reflexes, respiratory drive, and normal circulation. I accept this is
a fine line, but seems sensible and removes that guilty feeling one might
get when ones carefully titrated midazolam patient stops responding to voice
and requires more of a poke to ellicit a response (ie. at least localising,
eye opening and mumbling, implying a GCS of >=9). Not that I've ever had to
do that of course.
I've never used flumazenil in this context - totally agree with you on this
>If you need to "reverse" sedation then you have done it wrong. Conscious
>means the patient is able to respond to verbal commands. Anything else
>on general anaesthesia. I agree with the comment that flumazenil should be
>for those patients you cannot ventilate adequately.
>Flumazenil lowers the seizure threshold, hence to propensity for overdose
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