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Anesthesia and Sedation

  • May be used when pain or anxiety may impede performance and success

  • Relative Contraindications: old age, dementia, respiratory difficulty

  • Aim to use local anesthesia with l% to minimize procedural sedation

  • Creating wheal: clean surface w/ chlorhexidine or alcohol swab; with 22-25G needle, advance needle nearly parallel to skin and aspirate to ensure no blood vessel involved, then inject anesthetic to create 1-2 cm of raised skin; If deeper subcutaneous anesthesia is needed, advance needle perpendicular to skin, aspirate as advancing then inject the tract, inject anesthetic as needle is withdrawn

  • Local anesthesia can alter landmarks, always double check anatomy after injection

  • Minimal Sedation: 0.25mg-2mg Ativan IV or 1mg-2.5mg Midazolam IV

    • Midazolam (Versed): faster on (2-5 min) and faster off (30-60 min)

    • Lorazepam (Ativan): onset 5-10 min; Duration 4-8 hours