The Major Agents and the Role of the Nurse in Conscious Sedation
Smith, Matthew T. (Matt)
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Conscious sedation is ·a becoming more common in health care and the professionals (including physicians and nurses) administering the sedation must have knowledge about certain drugs, educational expectations, emergency situations, and the differences in patient populations. The medications used in conscious sedation are types of benzodiazepines and opiates. The main benzodiazepines discussed are diazepam, midazolam, lorazepam, and flumazenil. Morphine, fentanyl, and naloxone are the major opioids reviewed in this paper. The specific drug-drug interaction described is the competitive inhibition by fentanyl on the metabolism of midazolam by binding to the CYP3A4 isoform of hepatic microsomes. The nurse's role in administering conscious sedation is discussed concerning standards of practice, position statements, practice guidelines, competency, and patient assessments and monitoring. Various populations of patients (the critically ill, elderly, pediatric) need to be given special consideration by the health care professionals administering sedation.