USMLE Forum Archives - USMLE Step 2 CK - Surgery 1
Surgery 1
TheOne - 02-07-07 21:42
An otherwise healthy 4-years-old girl is brought to the emergency department because of a small 4-cm laceration in her forehead. The patient is crying and frightened. The practitioner decides to perform conscious sedation before suturing the laceration. Support personnel and equipment are available for monitoring the patient's vital
signs and carrying out resuscitation measures if needed. Which of the following is the most appropriate pharmacologic agent to achieve a safe level of conscious sedation in this patient?
A. Administring oral or rectal diazepam
B. Concomitant oral opioid and benzodiazepine administration
C. Intravenous propofol
D. Intravenous ketamine
E. Concomitant oral analgesic-sedative agents and muscle relaxants
TheOne - 02-07-07 21:42
An otherwise healthy 4-years-old girl is brought to the emergency department because of a small 4-cm laceration in her forehead. The patient is crying and frightened. The practitioner decides to perform conscious sedation before suturing the laceration. Support personnel and equipment are available for monitoring the patient's vital
signs and carrying out resuscitation measures if needed. Which of the following is the most appropriate pharmacologic agent to achieve a safe level of conscious sedation in this patient?
A. Administring oral or rectal diazepam
B. Concomitant oral opioid and benzodiazepine administration
C. Intravenous propofol
D. Intravenous ketamine
E. Concomitant oral analgesic-sedative agents and muscle relaxants
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#2
Re: Surgery 1
TheOne - 02-22-07 15:50 Explanation: The correct answer is A. Suturing a laceration is one of the most common situations in which sedation may be required in a child. Sedation may be classified as conscious or deep. By definition, during conscious sedation the patient is able to maintain airway patency, protective airway reflexes, and responses to physical stimuli. This level of sedation is indicated for children (or adult patients) who have not fasted prior to the procedure, or patients who do not require a deep level of sedation. Nevertheless, conscious sedation should be performed by appropriately trained personnel, and only when equipment for resuscitation measures is readily available, should the need arise.
For minor surgical procedures such as suturing uncomplicated linear lacerations, administration of a short-acting or long-acting benzodiazepine (midazolam or diazepam, respectively) by the oral or rectal route provides sufficient sedation. Intravenous access is not required. Intravenous midazolam or diazepam can be used for procedures that
produce more intense pain or discomfort, such as repair of complex lacerations, bone marrow aspiration, and reduction of fractures.
Concomitant opioid and benzodiazepine administration (choice B) is used to achieve not only sedation, but also an adequate level of analgesia. The synergistic action of opioids and benzodiazepines increases the risk of respiratory depression.
Intravenous propofol (choice C) provides rapid onset of sedation that resolves quickly once infusion is discontinued. This drug is used for procedures requiring deeper levels of sedation in appropriately fasted and stable children.
Intravenous ketamine (choice D) is an appropriate alternative to propofol. Its most common side effect is the production of visual and auditory hallucinations (about 10% of cases).
Concomitant analgesic-sedative agents and muscle relaxants (choice E) is employed for clinical procedures like tracheal intubation or endocopy, also in the peri-opereative preparation of the patients.
#4
Re: Surgery 1 babbu5508 - 07-06-10 23:00 A. Administring oral or rectal diazepam is the most appropriate pharmacologic agent to achieve a safe level of conscious sedation in this patient
#5
Re: Surgery 1 bingousmle - 07-11-10 02:40 Administring oral or rectal diazepam can achieve a safe level of conscious sedation in this patient to perform conscious sedation before suturing the laceration
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