3.

1
Pharmacology:
sedation/analgesia

Emmanouil S. Brilakis, MD, PhD

 PCI: the steps
1. Planning
2. Monitoring
3. Pharmacology
4. Access
5. Engagement
6. Angiography
7. Determine target lesion
8. Wiring
9. Lesion preparation
10. Stenting
11. Closure
12. Physiology
13. Imaging
14. Hemodynamic support
 Medication classes

1. Sedatives - Analgesics
2. Vasodilators
3. Contrast media
4. Anticoagulants
5. Antiplatelets
6. Vasopressors - Inotropes
7. Antiarrhythmics
 Medication classes

1. Sedatives - Analgesics
 Midazolam: 0.5 – 1 mg IV – can be
2. Vasodilators repeated.
3. Contrast media
Duration of action: 15-80 minutes
4. Anticoagulants
5. Antiplatelets
6. Vasopressors - Inotropes • Fentanyl: 25-100 mcg IV – can be
repeated
7. Antiarrhythmics
Duration of action: 30-60 minutes

• Morphine

1. Sedatives - Analgesics
2. Vasodilators
3. Contrast media
4. Anticoagulants
5. Antiplatelets
6. Vasopressors - Inotropes
7. Antiarrhythmics
Complications
 Respiratory depression
1. Stop administration
2. Reverse:
- Flumazenil (Romazicon): 0.2 mg over 15
sec – can given another 0.2 mg over 1
min up to 1 mg total
- Naloxone (Narcan): 0.1-0.2 mg IV – repeat
Q2-3 min
3. BiPAP - intubation
• Opioids can delay P2Y12 absorption