Most patients receive a pre-procedure anxiolytic such as oral diazepam (Valium) and/or intravenous (IV) midazolam (Versed), fentanyl, and local anesthetic, usually lidocaine, at the cannulation site. The use of a local anesthetic only at the sheath site would not require continuous airway monitoring, but the catheterization lab staff must be prepared to treat arrhythmias and allergic reactions to the radio-opaque dye used in any procedure.
The goal is comfort or “twilight sedation” not deep sedation. The patient should be able to answer questions and perform simple commands such as “take a deep breath” and “turn your head.”
A patient with active chest or arm pain may be given small doses of morphine or fentanyl intravenously for severe pain. This becomes moderate sedation and the RN should be credentialed in airway maintenance and the use of sedative hypnotics. ACLS is a prerequisite in most institutions prior to administering IV sedation.
Many elderly patients are very sensitive to narcotics and/or may have an adverse reaction to midazolam (Versed). Elderly patients may only require approximately half the amount of midazolam as healthy young patients if narcotic premedication or other central nervous system (CNS) depressants are used. (Micromedex, 2009)