Although medical student does not need a competent skill to perform general and regional anaesthesia to his/her patients, but they should be able to administer intravenous anaesthetics for a short procedure by themselves. According to the skill required by Thai Medical Council a sedation skill is a must for everyone, it means that you are expected to do it yourself when you are a new graduate physician.
When you are facing an uncooperative patient, you have to assess whether or not he can have an acceptable level of ventilation without need of help to assist the breathing, that would be A and B from ABC, so an acceptable of spontaneous respiration together with a good patent airway is a must. Then you have to evaluate the haemodynamics of your patient, for example a risk of hypovolaemia or dehydration in an urgent or emergent patient, or in an elective patient about the effects of NPO or prior diuretic treatment.
For the monitoring during your sedation it should be comparable to the anaesthetic standard, all basic non-invasive monitoring should be ready and function before you initiate medical titration of your sedative medications. The ingredients of your medications should be consisted of induction or sedative agents plus analgesics plus a supplement drug; such as antiemetics.
You can begin with any induction agents; thiopental- ok for in-patient, cheap and safe old drug, propofol- a drug that involves in Michael Jackson's death, good recovery for out-patient but more likely to have a hypotensive episode, ketamine- a good old drug with analgesic effect but delayed awakening and bad vivid dreams, or you can choose benzodiazepines as an inducing agent. The next or even first drug group is an analgesic, any choice would do, it really depends on your patient's plan of recovery, this drug class is quite safe however do not forget to monitor the respiratory effect and prophylaxis of vomiting this drug group might cause and that is the reason why you may need antiemetics as an extra!
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