Anesthesia
- May be used in which a pt’s pain or anxiety may impede performance and success
- Relative Contraindications: old age, dementia, respiratory difficulty
- Aim to use local anesthesia and minimize procedural sedation
- Local Anesthesia: lidocaine 1% or 2% – add Epi if >30 mins of analgesia required
- Creating wheal: clean surface w/ chlorhexidine or alcohol swab; with 22-25G needle, advance needle 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 Inject anesthetic as needle withdrawn.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