Drug regimens using nitrous oxide, midazolam or an opioid for conscious sedation in adults
If conscious sedation is appropriate for an adult, the following drug regimens may be used; see Principles of conscious sedation for a discussion of whether these regimens should be used alone or in combination. Additive drug effects are likely when the regimens are combined, and reduced doses may be required.
Nitrous oxide must only be used for conscious sedation by suitably trained and credentialed practitioners. If nitrous oxide is indicated for conscious sedation in adults, use:
1 nitrous oxide 50% with oxygen 50% via a patient-triggered device, inhaled intermittently to maintain adequate analgesia and sedation for the duration of the painful procedure1. Full analgesic effect is expected after 5 to 8 inhalations procedural sedation and analgesia, conscious sedation (adults) nitrous oxide
OR
1 nitrous oxide 50 to 75% with oxygen via a nonpatient-triggered system using continuous flow, inhaled to maintain adequate analgesia and sedation for the duration of the painful procedure. Full analgesic effect is expected after 5 to 8 inhalations. procedural sedation and analgesia, conscious sedation (adults) nitrous oxide
Opioids must only be used for conscious sedation by suitably trained and credentialed practitioners. If an opioid is indicated as part of combination therapy for conscious sedation in adults, use:
1 fentanyl 50 to 100 micrograms intravenously, as a single dose. If necessary, give 25 to 50 micrograms intravenously, every 5 minutes until adequate analgesia is achieved or a total dose of 200 micrograms has been administered. If additional doses are needed to provide adequate analgesia, seek specialist advice. Use the lower end of the dose range in older or frail patients, or if used in combination with midazolam procedural sedation and analgesia, conscious sedation (adults) fentanyl
OR
1 morphine 5 to 10 mg intravenously, as a single dose. If necessary, give 2.5 to 5 mg intravenously, every 5 minutes until adequate analgesia is achieved or a total dose of 20 mg has been administered. If additional doses are needed to provide adequate analgesia, seek specialist advice. Use the lower end of the dose range in older or frail patients, or if used in combination with midazolam procedural sedation and analgesia, conscious sedation (adults) morphine
OR
1 oxycodone 5 to 10 mg intravenously, as a single dose. If necessary, give 2.5 to 5 mg intravenously, every 5 minutes until adequate analgesia is achieved or a total dose of 20 mg has been administered. If additional doses are needed to provide adequate analgesia, seek specialist advice. Use the lower end of the dose range in older or frail patients, or if used in combination with midazolam. procedural sedation and analgesia, conscious sedation (adults) oxycodone
These doses may cause transient sedation; however, this is usually reversible if it is identified early and rapidly treated.
Midazolam must only be used for conscious sedation by suitably trained and credentialed practitioners. If midazolam is indicated as a component of combination therapy for conscious sedation in adults, use:
midazolam 1 mg intravenously, as a single dose. If necessary, give 1 mg intravenously, every 2 minutes until adequate sedation is achieved; a total dose of more than 5 mg is rarely needed. Use lower doses in older or frail patients, or if used in combination with an opioid. procedural sedation and analgesia, conscious sedation (adults) midazolam