Minimal Sedation
Minimal Sedation
"Anxiolysis"
Normal Response to Verbal Commands.
Cognitive Function and Physical Coordination may be Impaired.
Cardiovascular, Ventilation, and Airway are
not Altered.
"Examples of Minimal Sedation are
(1) less than 50% nitrous oxide in oxygen with no other sedative or analgesic medications by any route
(2) a single, oral sedative or analgesic medication administered in doses appropriate for the unsupervised treatment of anxiety or pain."
Dosing
Maximum Recommended Dose (MRD)
"Maximum FDA-recommended dose of a drug as printed in FDA-approved labeling for unmonitored home usage"
"Minimal sedation may be achieved by the administration of a drug either singly or in divided doses, by the enteral route to achieve the desired clinical effect, not to exceed the maximum recommended dose (MRD)."
"The administration of enteral drugs exceeding the MRD during a single appointment
is considered to be moderate sedation..."
"If more than one enteral drug is administered...the guidelines for moderate sedation apply."
Find "MRD"s by Web searching "FDA (medication name) Labeling"
FDA Diazepam Labeling
Peak Plasma Concentration 0.25 to 2.5 hours
Elimination half-life up to 48 to 100 hours
FDA Lorazepam Labeling
Peak Plasma Concentration approximately 2 hours
Mean half-life about 12 hours
FDA Triazolam Label
Peak Plasma Concentration within 2 hours
Mean Plasma half-life 1.5 to 5.5 hours
Redosing
Titration
Dose Stacking
Administering incremental doses to reach a desired effect.
This is now Moderate Sedation (or deeper).
"Must know whether the previous dose has taken full effect before administering an additional drug increment".
For oral dosing--very long (hours) before peak effects so
redosing or titration on same day will require subsequent intravenous dosing.
"Oral medications should not be 'titrated' at the same appointment on the same day, but
must reserve sedative administration dose changes to a subsequent appointment".
If requiring any airway support or not responding to verbal commands then,
patient has slipped deeper than minimal and moderate sedation!
