7. Oral Sedation Flashcards
5-10% Americans have dental phobia and avoid care completely
80% have ____
Even pts that can come in and accomplish procedure with LA (local anesthesia)
If given alternative, would accept that and consider oral sedation as adjunct to their dental procedure
dental anxiety
____ is for little scaredy cats while
Oral sedation is for those that are more anxious
7-15% Americans very nervous or terrified of having dental Tx
May not be right group for oral sedation, they may need deep or GA
Preferably GA, since if have to be that deep to have procedure accomplished, creates potential airway problem
GA is for big scaredy cats
Can’t even do it with oral or deep sedation ambulatory anesthesia, may become more combative with some sedation on board.
In those patients, ____ is the only solution
NO
GA
Why are people so afraid of dentist? -Bad past ____
-Learned ____ from parent Kids pick up cues from parents
If parents are nervous, they may have conversations with them before a procedure making it difficult to negate what they’ve been told by parents
-Fear of pain: can be alleviated with ____
If you’re working on a pt and they’re not completely numb, are they overly sensitive? Can test gum to see if they really feel it or if they’re just nervous
Might jump even before you touch them if they’re just afraid
Not actually feeling it
-Fear of ____
Drills, needles
If pts know that NO or sedation can get them through a procedure, they can be more reasonable Really first 5-10 minute interaction is important in managing fear of dental procedures
-Embarrassment about poor ____
experiences behavior LA dental instruments OH
ADA guidelines
❖ “ a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an ____ and respond appropriately to physical stimulation or verbal command . . .”
airway
Oral sedatives will most likely be between ____ categories
Normal response to verbal stimulation, airway, ventilation, CV function unaffected in minimal
In ____, there is a purposeful response to verbal or tactile stimulation though they look sedated, no airway intervention required, adequate ventilation, usually maintained CV function
____ may require intervention in airway, they may have questionable ventilation. GA may impair CV function
minimal and moderate
moderate
deep
We want to keep them relaxed, anxiolysis, but with consciousness maintained Pts may doze in and out of sleep
Don’t say they’ll be asleep because that’s more like GA in OR with a breathing tube Tell pts it is to relax, to control ____, but not for pain
____ is for pain and will be used in all forms of sedation
But they’ll doze in and out, close eyes, get comfortable
But can easily arouse them, call out name, touch, and they will respond
Not trying to depress consciousness, just ____ them and make our lives easier
anxiety
LA
relax
Oral Sedation: Benefits ❖ \_\_\_\_ to administer ❖ Provides anxiety relief ❖ \_\_\_\_ to use ❖ Lower cost ❖ No need for \_\_\_\_ training in parenteral sedation or general anesthesia
easy
safe
advanced
Level of sedation
❖ Minimal sedation is equivalent to ____, that is, a drug-induced relief of apprehension with minimal effect on sensorium
anxiolysis
Oral Sedation: Limitations
❖ Reliance on patient ____
Have to trust pt will take medication and follow instructions, not take anything else
❖ ____ onset of drug action
Can’t have them go fill rx on the spot and come back and take it, the effect would take an hour
❖ ____ absorption from
the GI tractIf there are other GI issues there can be problems. Ex, 26 yo F with gastroparesis is also taking pain meds and isn’t getting sedated.
There’s also normal variation bw pts (30min vs 2hrs to take effect)
❖ Inability to ____ the dose
❖ Difficult to administer ____
compliance delayed erratic and incomplete titrate reversal agent
Most Commonly Used
❖ ____
❖ Hydroxyzine (Vistaril)
❖ ____
benzodiazepines
choral hydrate
Benzodiazepines ❖ \_\_\_\_ (Valium) ❖ Midazolam (Versed) ❖ \_\_\_\_ (Ativan) ❖ Alprazolam (Xanax) ❖ \_\_\_\_ (Restoril) ❖ Triazolam (Halcion)
diazepam
lorazepam
temazepam
Oral Sedation: Benzodiazepines ❖ Diazepam (Valium) ❖ Available in \_\_\_\_ suspension ❖ Minimal \_\_\_\_ and respiratory effects ❖ Used \_\_\_\_ or in combo ❖ Long elimination \_\_\_\_
tablets
cardiovascular
solo
half-life
Diazepam: Advantages
❖ Wider margin of ____
❖ Can administer in doses sufficient for ____
safety
anxiolysis
Diazepam: Disadvantages ❖ Production of active ____
metabolites
Diazepam: Pharmacokinetics ❖ Reaches peak concentrations rapidly ❖Adults: \_\_\_\_ min ❖Children: \_\_\_\_ min ❖ Half-life of \_\_\_\_ days
60 to 90
15 to 30
1.5
