May be used when pain or anxiety may impede performance and success
Relative contraindications: old age, dementia, respiratory difficulty.
Aim to use local anesthesia with l% to minimize procedural sedation
Creating wheal: Clean surface with chlorhexidine or alcohol swab. With 22-25G needle, advance needle nearly 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advance needle perpendicular to skin, aspirate as advancing then inject the tract and inject anesthetic as needle is withdrawn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)
