Sedation Patient Instructions
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Early Morning Insomnia, Daytime Anxiety, and Organic Mental Disorder Associated with Triazolam
Early Morning Insomnia, Daytime Anxiety, and Organic Mental Disorder Associated with Triazolam Tjiauw-Ling Tan, MD, Edward 0. Bixler, PhD, Anthony Kales, MD, Roger J. Cadieux, MD, and Amy L. Goodman, MD Hershey, Pennsylvania A psychiatric syndrome characterized by agita Sleep Disorders Clinic. He began taking triazolam tion, paranoid ideation, depersonalization, and de at bedtime in a 0.5-mg dose eight months before pression, as well as paresthesias and hyperacusis, his referral. Although the drug was effective ini has been attributed to administration of triazolam tially, tolerance developed, causing the patient to (Halcion).1 The occurrence of these reactions led gradually increase the dosage until eventually he to the removal of the drug from the market in the was taking a total of 1.5 mg nightly. Netherlands. Isolated behavioral side effects that The physical examination revealed no contribu include amnesia2-4 and hallucinations5 have also tory conditions. However, assessment of the pa been reported with administration of triazolam. tient’s mental status revealed that he was extreme Rebound insomnia6 and early morning insom ly guarded and suspicious and preoccupied with nia,7 both associated with increases in daytime his sleeplessness to the degree that this hypochon anxiety,7,8 are withdrawal syndromes known driacal concern had a delusional quality. He also to occur with rapidly eliminated benzodiazepine described two episodes indicating memory impair hypnotics such as triazolam. Rebound insomnia ment; both incidents occurred in the late afternoon consists of a marked increase in wakefulness and involved preparing to eat certain foods, which above baseline levels following drug withdrawal. -
MEDICATION GUIDE RESTORIL™ (Res-Tə-Ril) (Temazepam) Capsules
MEDICATION GUIDE RESTORIL™ (res-tə-ril) (temazepam) Capsules, C-IV What is the most important information I should know about RESTORIL? RESTORIL is a benzodiazepine medicine. Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, breathing problems (respiratory depression), coma and death. After taking RESTORIL, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night. You have a higher chance for doing these activities if you drink alcohol or take other medicines that make you sleepy with RESTORIL. Reported activities include: o driving a car (“sleep-driving”) o making and eating food o talking on the phone o having sex o sleep-walking Call your healthcare provider right away if you find out that you have done any of the above activities after taking RESTORIL. Do not take RESTORIL unless you are able to stay in bed a full night (7 to 8 hours) before you must be active again. Do not take more RESTORIL than prescribed. What is RESTORIL? RESTORIL is a prescription sleep medicine. RESTORIL is used in adults for the short-term (usually 7 to 10 days) treatment of a sleep problem called insomnia. Symptoms of insomnia include trouble falling asleep and waking up often during the night. RESTORIL is a federal controlled substance (C-IV) because it can be abused or lead to dependence. Keep RESTORIL in a safe place to prevent misuse and abuse. -
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin Healthcare
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin healthcare 4/22/2020 Overview benzodiazepines • Examples of benzos and benzo like drugs • Indications for benzos • Pharmacology of benzos • Side effects and contraindications • Benzo withdrawal • Benzo tapers 12/06/2018 Sedative/Hypnotics • Benzodiazepines • Alcohol • Z-drugs (Benzo-like sleeping aids) • Barbiturates • GHB • Propofol • Some inhalants • Gabapentin? Pregabalin? 12/06/2018 Examples of benzodiazepines • Midazolam (Versed) • Triazolam (Halcion) • Alprazolam (Xanax) • Lorazepam (Ativan) • Temazepam (Restoril) • Oxazepam (Serax) • Clonazepam (Klonopin) • Diazepam (Valium) • Chlordiazepoxide (Librium) 4/22/2020 Sedatives: gaba stimulating drugs have incomplete “cross tolerance” 12/06/2018 Effects from sedative (Benzo) use • Euphoria/bliss • Suppresses seizures • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Sleep inducing • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 Tolerance to benzo effects? • Effects quickly diminish with repeated use (weeks) • Euphoria/bliss • Suppresses seizures • Effects incompletely diminish with repeated use • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Seep inducing • Durable effects with repeated use • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 If you understand this pharmacology you can figure out the rest... • Potency • 1 mg diazepam <<< 1 mg alprazolam • Duration of action • Half life differences • Onset of action • Euphoria, clinical utility in acute -
Statement on Safe Use of Propofol 2019
Statement on Safe Use of Propofol Committee of Origin: Ambulatory Surgical Care (Approved by the ASA House of Delegates on October 27, 2004, and amended on October 23, 2019) Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Due to the potential for rapid, profound changes in sedative/anesthetic depth and the lack of antagonist medications, agents such as propofol require special attention. Even if moderate sedation is intended, patients receiving propofol should receive care consistent with that required for deep sedation. The Society believes that the involvement of an anesthesiologist in the care of every patient undergoing anesthesia is optimal. However, when this is not possible, non-anesthesia personnel who administer propofol should be qualified to rescue* patients whose level of sedation becomes deeper than initially intended and who enter, if briefly, a state of general anesthesia.** • The physician responsible for the use of sedation/anesthesia should have the education and training to manage the potential medical complications of sedation/anesthesia. The physician should be proficient in airway management, have advanced life support skills appropriate for the patient population, and understand the pharmacology of the drugs used. The physician should be physically present throughout the sedation and remain immediately available until the patient is medically discharged from the post procedure recovery area. • The practitioner administering propofol for sedation/anesthesia should, at a minimum, have the education and training to identify and manage the airway and cardiovascular changes which occur in a patient who enters a state of general anesthesia, as well as the ability to assist in the management of complications. -
Triazolam (Halcion®) Instructions
Mark Sebastian, DMD 33516 Ninth Ave. South, #2 Federal Way, WA 98003 (253) 941-6242 --or -- (253) 952-2005 [email protected] www.MarkSebastianDMD.com Triazolam (Halcion®) instructions If prescribed, take the diazepam (Valium®) pill just before bed the night before your dental surgery for a better night’s sleep. If you take other sleeping medications, take those instead of the diazepam (Valium®). Do not mix the two. If you have a morning appointment, you should to fast from solid foods after midnight. If you have an afternoon appointment, have a light breakfast. Unless you have a medical reason to eat (diabetic, etc.), do not eat anything for 6 hours before your appointment time. Water, apple juice, and black decaffeinated coffee/tea are OK for 3 hours before your appointment. Triazolam (Halcion®) is absorbed better on an empty stomach. Do not take caffeine or sugar) for 3 hours before your appointment, as all are stimulants that decrease the effectiveness of triazolam (Halcion®). No tobacco use for 8 hours before, as it is a stimulant. Take the triazolam (Halcion®) or diazepam (Valium®) pill(s) with a glass of water. Sparkling water makes them absorb better. Alcohol---do not drink within 24 hours before to 24 hours after taking triazolam (Halcion®) or diazepam (Valium®). Recreational/illegal drugs---Do not use for 7 days before your dental surgery and until 7 days after (never if you are taking narcotic pain medication). Example—using cocaine and then having local anesthetics (novocaine) can kill you. Do not take triazolam (Halcion®) or diazepam (Valium®) if you are allergic to triazolam (Halcion®), alprazolam (Xanax®), chlordiazepoxide (Librium®, Librax®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), estazolam (ProSom®), flurazepam (Dalmane®), lorazepam (Ativan®), oxazepam (Serax®), prazepam (Centrax®), temazepam (Restoril®). -
Intravenous Sedation and Preparing for Your Procedure
Oral and Maxillofacial Surgery Intravenous sedation and preparing for your procedure Information for patients Please ensure that you read this leaflet before you come to hospital for your operation What is sedation? Sedation is a way of using drugs (sedatives) to make you feel relaxed and sleepy during your procedure. We will give you your sedatives through an injection into a vein. Sedation is not a general anaesthetic and you will not be unconscious. You may not remember much of what happens during the procedure and directly afterwards. This is quite normal. Local anaesthetic will be given once you have been sedated. Do not drive, operate machinery or sign important documents for at least 24 hours after your procedure. You must make sure that you have a responsible adult with you who can stay in the department for a couple of hours and take you home by car or taxi. Someone must also stay with you for at least 24 hours after your procedure. Your procedure will be cancelled if you do not bring someone with you who can do this. Preparation for your procedure and what to bring with you • Patients having a procedure under sedation must follow the current fasting guidelines for general anaesthesia. You must not eat or drink for 6 hours before your procedure but you may have water up to 2 hours before. If you do eat or drink after these times your surgery will be cancelled. • Avoid alcohol for 24 hours before your procedure. • Bring with you a list of any medication or drugs you are taking. -
Effects of Benzodiazepines on Sleep and Wakefulness
Br. J. clin. Pharmac. (1981), 11, 31S-35S EFFECTS OF BENZODIAZEPINES ON SLEEP AND WAKEFULNESS T. ROTH, F. ZORICK, JEANNE SICKLESTEEL & E. STEPANSKI Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan The differential effects of short and long acting benzodiazepines on sleeping and waking behaviour are discussed, with particular reference to hypnotic efficacy, and their effects on the structure ofsleep and daytime function. Introduction THE evaluation of any drug requires an understand- et al., 1979), and triazolam (Metzler et al., 1977) have ing of the conditions in which it is going to be used come into clinical use. The present report will present clinically. In the case of hypnotics, the most appro- the differential effects of short- and long-acting ben- priate use is symptomatic relief for the complaint of zodiazepines on sleeping and waking behaviour. insomnia. To understand fully the safety and efficacy ofthese drugs, we must first be aware of the constella- tion of symptoms associated with the complaint of Sleep parameters insomnia, as well as what these drugs do to each of these symptoms. In evaluating the effects of hypnotics on sleep, two Insomnia is a complaint. Although all of the types of parameters should be considered. The first aetiological factors which give rise to this symptom set of parameters deal with hypnotic efficacy and are not currently well understood, there is an accepted include measures such as latency to sleep onset, total diagnostic system for the various disorders associated sleep time, number and duration of awakenings, and with disturbed nocturnal sleep (Association of Sleep sleep efficiency. -
Moderate Sedation Study Guide 11-17-10
PROCEDURE RELATED SEDATION Outline I Introduction II Definitions: The 5 Levels of Sedation and Anesthesia III Emergency Procedures, Critical Care Areas and Policy Exclusions IV The Pre-Sedation Assessment V NPO: The Timing of Eating and Drinking before Sedation VI Review of Some Agents Used for Sedation VII Orders for Procedure Related Sedation VIII Environmental Requirements and Monitoring During Sedation IX Post-Procedure Monitoring and the PAR Score X Discharge Criteria and Concluding Post-Procedure Monitoring 1 PROCEDURE RELATED SEDATION Lance Brown, MD, MPH I. Introduction The purpose of this tutorial is to familiarize the reader with the Loma Linda University Medical Center Policy M-86 for Procedure Related Sedation. Procedure related sedation is used to make necessary medical procedures as comfortable as possible for patients and to facilitate the performance of necessary medical procedures by health care providers (typically physicians). It is important for health care providers performing procedure related sedation to be familiar with the pharmacologic characteristics of the agents being used, to understand the risk factors for complications related to procedure related sedation, and to individually plan the sedation for each patient. Each health care practitioner privileged to provide procedure related sedation takes responsibility for both the comfort and safety of the patients in their care. II. Definitions At Loma Linda University Medical Center, we have defined five distinct levels of sedation and anesthesia. Familiarity with the definitions of these levels of sedation is important for safely providing procedure related sedation and for complying with the policy of the Medical Center. It must be recognized, however, that sedation occurs along a continuum and that individual patients may have different degrees of sedation for a given dose and route of medication. -
Comparison of Short-And Long-Acting Benzodiazepine-Receptor Agonists
J Pharmacol Sci 107, 277 – 284 (2008)3 Journal of Pharmacological Sciences ©2008 The Japanese Pharmacological Society Full Paper Comparison of Short- and Long-Acting Benzodiazepine-Receptor Agonists With Different Receptor Selectivity on Motor Coordination and Muscle Relaxation Following Thiopental-Induced Anesthesia in Mice Mamoru Tanaka1, Katsuya Suemaru1,2,*, Shinichi Watanabe1, Ranji Cui2, Bingjin Li2, and Hiroaki Araki1,2 1Division of Pharmacy, Ehime University Hospital, Shitsukawa, Toon, Ehime 791-0295, Japan 2Department of Clinical Pharmacology and Pharmacy, Neuroscience, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan Received November 7, 2007; Accepted May 15, 2008 Abstract. In this study, we compared the effects of Type I benzodiazepine receptor–selective agonists (zolpidem, quazepam) and Type I/II non-selective agonists (zopiclone, triazolam, nitrazepam) with either an ultra-short action (zolpidem, zopiclone, triazolam) or long action (quazepam, nitrazepam) on motor coordination (rota-rod test) and muscle relaxation (traction test) following the recovery from thiopental-induced anesthesia (20 mg/kg) in ddY mice. Zolpidem (3 mg/kg), zopiclone (6 mg/kg), and triazolam (0.3 mg/kg) similarly caused an approximately 2-fold prolongation of the thiopental-induced anesthesia. Nitrazepam (1 mg/kg) and quazepam (3 mg/kg) showed a 6- or 10-fold prolongation of the anesthesia, respectively. Zolpidem and zopiclone had no effect on the rota-rod and traction test. Moreover, zolpidem did not affect motor coordination and caused no muscle relaxation following the recovery from the thiopental-induced anesthesia. However, zopiclone significantly impaired the motor coordination at the beginning of the recovery. Triazolam significantly impaired the motor coordination and muscle relaxant activity by itself, and these impairments were markedly exacerbated after the recovery from anesthesia. -
Red with Nitrazepam and Placebo in Acute Emergency Driving Situations and in Monotonous Simulated Driving
109 A 1986 The Carry-over Effects of Triazolam Compa- red with Nitrazepam and Placebo in Acute Emergency Driving Situations and in Mono- tonous Simulated Driving Hans Laurell and Jan Törnroos Reprint from Acta Pharmacologica et toxicologica 1986 v Väg06/7 Efi/( Statens väg- och trafikinstitut (VTI) * 581 01 Linköping [St]tlltet Swedish Road and Traffic Research Institute * S-581 01 Linköping Sweden Acta pharmacol. et toxicol. 1986, 58, 182186. From the National Swedish Road and Traffic Research Institute, (V.T.I.), S-58 101 Linköping, Sweden The Carry-over Effects of Triazolam Compared with Nitrazepam and Placebo in Acute Emergency Driving Situations and in Monotonous Simulated Driving Hans Laurell and Jan Törnros (Received October 9, 1985; Accepted January 9, 1986) Abstract: Eighteen healthy volunteers of both sexes, aged 2034, were tested in the morning while undertaking real car driving avoidance manoeuvres and during monotonous simulated driving after 1 and 3 nights of medication with triazolam 0.25 mg, nitrazepam 5 mg or placebo. The study was a double-blind, randomized, cross-over study, where a minimum of 7 days wash-out separated the 3 treatment periods. Nitrazepam was found to impair performance in the simulated task after 1 but not after 3 nights of medication. Performance in the triazolam condition was not signicantly different from the other conditions on this task on either day. However, after one night of medication triazolam tended to score worse than placebo but better than nitrazepam. In real car driving a tendency was noted for nitrazepam to score worst, whereas the difference between placebo and triazolam was hardly noticeable. -
Oral Sedation Instructions
Following your child’s appointment (Cont’d) DIET DO NOT feed your child until he/she is completely awake. Begin feeding with clear, pulp-free liquids such as water, apple juice, jello, popsicles or “sports” drinks. Start your child on semi-solid foods (such as soup, noodles, porridge, INSTRUCTIONS FOR PATIENTS WHO WILL BE oatmeal) for easy chewing and digestion. Only feed your child if RECEIVING ORAL SEDATION he/she is hungry and has tolerated clear liquids without vomiting. Avoid feeding your child large portions of food or fatty foods such as French fries. Goals of conscious sedation If your child vomits, stop feeding for 30-60 minutes then gradually resume clear fluids in sips. The goals of sedation in the pediatric patient for diagnostic and therapeutic Normal diet can be resumed as soon as he/she is ready for it. procedures are: 1) to guard the patient’s safety and welfare; 2) to minimize physical discomfort and pain; 3) to control anxiety, minimize psychological PAIN trauma, and maximize the potential for amnesia; 4) to control behavior and/or movement so as to allow the safe completion of the procedure; and 5) You will be notified if local anesthetic has been used during the to return the patient to a state in which safe discharge from medical procedure. It usually takes 2-3 hours to completely wear off. Make supervision, as determined by recognized criteria, is possible. sure you monitor your child closely to avoid any soft tissue trauma. The sedatives If he/she complains of pain, regular strength children’s Tylenol or Advil/Motrin is usually sufficient. -
Post-Intubation Analgesia and Sedation
POST-INTUBATION ANALGESIA AND SEDATION August 2012 J Pelletier Intubated patients experience pain and anxiety Mechanical ventilation, endotracheal tube Blood draws, positioning, suctioning Surgical procedures, dressing changes Awareness during neuromuscular blockade Invasive catheters Loss of control Unrelieved pain and anxiety cause adverse effects Self-injury and removal of life-sustaining devices Increased endogenous catecholamines Sleep deprivation, anxiety, and delirium Impaired post-ICU psychological recovery Emotional and posttraumatic effects Ventilator dysynchrony Immunosuppression Treating pain and anxiety improves outcomes Use of pain and sedation scales in critically ill patients allows: precise dosing reduced medication side effects reduced ICU and hospital length of stay shorter duration of mechanical ventilation Analgesics should be provided first, then anxiolysis If you were intubated, how much lorazepam or midazolam, and fentanyl would you want per hour? Intubated ED patients receive inadequate analgesia and sedation Retrospective study, tertiary ED 50% received no analgesia, 30% received no anxiolytic Of patients receiving postintubation vecuronium, 96% received either no or inadequate anxiolysis or analgesia Overall, 3 of 4 patients received no or inadequate analgesia and an equivalent number received no or inadequate anxiolysis Bonomo 2007 Analgesia: opioids Bind CNS and peripheral tissue receptors Mu-1 receptors: analgesia Mu-2 receptors: respiratory depression, vomiting, constipation, and