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PEDO (Spring) > 2. Sedation > Flashcards

2. Sedation Flashcards

1
Q

What are the advanced behavior guidance strategies

A
  • Protective stabilization
  • Sedation
  • General anesthesia
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2
Q

What are the four stages of Piaget’s stages of cognitive development

A
  • Sensorimotor stage
  • Preoperational stage
  • Concrete operational stage
  • Formal operaitons
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3
Q

Describe the Piaget’s sensorimotor stage

A
  • Birth to 24 months
  • Little to no meaningful verbal communication
  • Hyperaware of people around them
  • Perceptive to non-verbal communication
  • **Key feature= object permanence (meaning they understand objects exist even if they can’t physically see them in that moment)
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4
Q

Describe the Piaget’s preoperational stage

A
  • 2-5 years
  • Begin to use language
  • Can form mental symbols
  • Language is concrete and literal
  • Limited logical reasoning
  • Egocentric view of the world
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5
Q

Describe the Piaget’s Concrete operational stage

A
  • 6-11 y/o
  • Increased logical reasoning
  • Still have hard time with abstract ideas
  • Benefit from concrete instructions
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6
Q

Describe the Piaget’s formal operation stage

A
  • 11+ years
  • Can think about abstrations and hypothetical concepts
  • Reason analytically
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7
Q

What are the three classifications of temperment classified by Chess and Thomas and describe each

A

Easy temperment

  • Mostly positive mood with mild/moderate intensity
  • Adapts quickly
  • Approaches new situations

Difficult temperment

  • Withdraws from new situations
  • Slow adaptability
  • Negative emotion of high intensity

Slow to warm up temperment

  • Shy
  • Slow adatability
  • Negative emotional expressions of low intensity
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8
Q

At what age do kids start to warm up to strangers (separate from parents)

A

school age

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9
Q

What are the typical fears of an infant/todler

A
  • Strangers
  • Loud sounds
  • Sudden movements
  • Falling
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10
Q

Lap exams should be done for what ages

A

infants/toddlers (good for parental involvement)

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11
Q

At what age can kids be managed with language

A

pre-school age

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12
Q

What are the different variables associated with uncooperative behavior

A
  • Dental fear (realistic v.s theoretical)
  • Demographics (race, gender, household,etc.)
  • Coping skills (generally increases with age and varies among individuals)
  • Pain (Subjective, anxiety upregulated pain)
  • Parental anxiety
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13
Q

Difference between realistic and theorized dental fear

A

Realistic is they have had the bad experience themselves and theorized is when someone tells them a bad experience

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14
Q

Define minimal sedation

A
  • Drug induced state (Still conscious)
  • Responds normally to verbal commands
  • impaired cognitive and coordination
  • Ventilation and CV function unaffected
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15
Q

Moderate sedation definition

A
  • Respond to purposeful commands (Still conscious)
  • No intervention required to maintain airway
  • Spontaneous ventilation adequate
  • CV function usually maintained
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16
Q

Deep Sedation

A
  • Still conscious
  • Can’t be easily aroused (respond to repeated purposeful or painful stimuli)
  • Ability to maintain airway and ventilation may be impaired
  • Spontaneous ventilation may be inadequate
  • May be partial or complete loss of protective airway reflexes
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17
Q

General anesthesia definition

A
  • Unconscious
  • Not arousable
  • Ability to maintain airway often impaired
  • CV function may be impaired
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18
Q

Routes of sedation agents

A
  • Inhalation *
  • Oral**
  • Nasal
  • Rectal
  • Submucosal
  • Intramuscular
  • IV
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19
Q

What are the disadvantages of oral sedation and advantages

A

Advantages

  • Often well tolerated
  • No pain

Disadvantages

  • Most variable
  • Can’t titrate
  • Reversal is tough
  • Recovery time may be prolonged
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20
Q

Why is oral sedation highly variable

A

dependent on absorption of GI mucosa

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21
Q

Recovery time of oral sedation is dependent on

A

metabolism of the drug

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22
Q

What are common pharmacologic classes of oral sedation meds

A
  • Anti-histamines
  • Benzodiazepines
  • Sedative hypnotics
  • Narcotics
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23
Q

Antihistamines used for oral sedation include

A
  • Hydroxyzine
  • diphenydramine (benadryl)
  • promethazine (phenergan)
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24
Q

Benzos used for oral sedation are

A
  • Diazepam (valium)

- Midazolam (versed)

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25
Q

What sedative hypnotic drug is used in oral sedation

A

chloral hydrate

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26
Q

Narcotics used for oral sedation are

A
  • Meperidine (Demerol)

- Sufentanil (intranasal)

27
Q

What is the antagonist of narcotics

A

naloxone (narcan)

28
Q

Narcan is given (IV/IM)

A

both

29
Q

Benzo antagonist is

A

flumenazil

30
Q

Flumenazil is administered how

A

IV

31
Q

What ASA classification should a child be for sedation

A

ASA I

ASA II with consideration**

32
Q

Uncontrolled asthma are (good/bad) candidates for sedation are

A

bad

33
Q

T/F LA is still needed with sedation

A

t

34
Q

Describe the 5 different classifications of tonsil size

A
    • Keep in mind child tonsils are larger than adult tonsils**
  • 0= Surgically removed tonsils
  • 1= Tonsils hiden within tonsil pillars
  • 2= Tonsils extending to the pillars
  • 3= tonsils are beyond the pillars
  • 4=Tonsils extend to midline
35
Q

Caution should be used with sedation with kids that fall under the classification of _ tonsils

A

3 and greater

36
Q

Sedation contraindications

A
  • Patient able to be managed with basic behavior management
  • ASA III and greater (and some ASA II)
  • Extensive treatment plan (should do general anesthesia)
  • Recent illness
37
Q

Sedation complications

A
  • Compromised airway (hypoventilation, hypoxemia, apnea, hypotension and cardiopulmonary arrest)
  • Seizure
  • Allergy
  • Failure to sedate (kids start crying/ become hyperactive)
38
Q

Instruction to parents for sedation

A
  • Notify of changes in child’s health (recent illness ie.)
  • Restricted food and liquids prior to sedation
  • Loose fitting clothes
  • Don’t bring other kids to appointment
  • Have two adults some one can monitor child’s breathing
39
Q

Why are food and liquids restricted prior to sedation

A
  • Reduce risk of aspiration if nauseous

- Better absorption of sedative meds on empty stomach

40
Q

What are the min. fasting periods for each item

  • Infant formula
  • Light meal (not fatty food)
  • Clear liquid
  • Non-human milk
  • Breast milk
A
  • Infant formula 6 hr
  • Light meal 6 hr
  • Clear liquid- 2hr
  • Non-human milk - 6hr
  • Breast milk - 4 hr
41
Q

What should you do if the child falls asleep after the appointment

A
  • Check breathing every 3-5 mins

- If snoring occurs reposition the head by lifting chin

42
Q

How long should a parent watch the child after the appointment

A

the whole day

43
Q

What are occasional side effects of sedation

A

nausea and vomiting

44
Q

What should be given for post op pain

A

tylenol or motrin (can also use if child has mild fever and pain afterward)

45
Q

How should food be reintroduced after sedaiton

A
  • Small amounts of liquids

- Move up to solid foods as tolerated

46
Q

Minimum of _ number of people are needed when sedating

A

2 (practioner and assistant)

47
Q

Roles of practitioner and assitant

A

Practitioner

  • Treatment
  • Drug admin.
  • Have skills to rescue

Assistant

  • Monitor vitals
  • Assist in rescue
  • Emergency cart
48
Q

Monitoring of vitals should include

A
  • Pulse oximeter
  • BP
  • Monitor ventilation (precordial stethoscope or capnograph)
49
Q

Recording or respiration rate (ventilation) occurs how frequently

A

every 5 min

50
Q

BP should be recorded how often

A

every 5 min

51
Q

Pulse oximeter is monitored how frequently

A

continuous

52
Q

T/F Sedative drugs can be given to children outside the dental facility

A

f

53
Q

What on-site monitoring devices are needed for rescue

A
  • Emergency cart
  • Must have necessary equipment to resuscitate a non-breathing child non-concious kid
  • Must be able to provide continuous life support
  • Equipment/drugs checked and maintained
54
Q

What does SOAPME stand for

A 
S= suction 
O= Oxygen
A= Airway 
P=Pharmacy (basic life support drugs) 
M= Monitors
E= Equipment (AED/Defibrillator)
55
Q

Health evaluation before sedation must look at what parameters

A
  • Health history
  • ROS
  • Age/weight
  • Baseline vitals (HR, BP, Respiratory rate, and temp)
  • Physical exam (airway eval)
56
Q

What should be documented during treatment

A
  • Time-based record: Name route, site, dose, and pt effect of administered drugs
  • Documents inspired conc. of O2 and N2O during administration
  • Continuous monitoring of O2 saturation and heart rate
  • Intermittent recording of BP and respiratory rate
57
Q

Documentation after treatment

A
  • Time and condition of child

- Document O2 sat on room air is safe for discharge

58
Q

Discharge criteria

A
  • CV function is satisfactory and stable
  • Airway patency is satisfactory and stable
  • Patient is easily arousable
  • Responsiveness is at or very near pre-sedation level
  • protective reflexes are intact
  • Can talk (return to pre-sedation level)
  • Patient can sit up unaided
  • State of hydration is adequate
  • Can remain awake for at least 20 min in a quiet environment
59
Q

Young kids are particularly vulnerable to what sedation risks

A
  • Effects on respiratory drive
  • Patency of airway
  • Protective reflexes
  • *Hypoxemia, laryngospasm, pulmonary aspiration, and apnea)
  • Common for kids to fall into deeper level of sedation than intended
60
Q

Max dose of articane

A

7mg/kg

61
Q

Max dose of midazolam

A

0.25 mg - 1mg/kg (max single dose is 20 mg)

62
Q

What level of conscious sedation is most desirable to achieve

A

moderate

63
Q

Treatment under LA should be limited to how many quads

A

1-2

PEDO (Spring) (9 decks)

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