adult sedation Flashcards
What are the steps we can take to manage a patient in levels of severity?
- Communication2. LA3. Psychological techniques 4. Inhalation sedation 5. IV sedation 6. General anaesthetic
Why is there a need for sedation?
- Theres a high Prevalence of dental anxiety2. Its Stressful for the dentist to manage anxious patients 3. GDC obligations
Define conscious sedation
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.
Who needs sedation?
- needle/ dental phobic2. Patients who have a strong gag reflex3. If the dental procedure is especially unpleasant4. Patients with medical conditions
Name some medical conditions that can be| aggravated by the stress of dental treatment
- Moderate ischaemic heart disease2. Mild hypertension 3. Mild Epilepsy4. Mild Asthma
Name some medical conditions that can be| affect co coperation
- Parkinson’s disease2. Spasticity disorders3. Mild mental or physical handicap
Name some social Contraindications to sedation
- Alcohol use2. Drug use3. Lack of an appropriate adult escort 4. Consent issues5. Interactions with sedative drugs6. Not safe
Name some medical Contraindications to sedation
- Severe / uncontrolled / un-investigated systemic disease2. Medication interactions with sedative agent3. Allergy to sedative agent4. Pregnancy5. Psychosis6. Respiratory infection
What scale do we use to judge a patients Anaesthesiology Classification?
American Society of Anaesthesiology Classification of Physical Status (ASA)
Describe a patient placed in the 1st class of the American Society of Anaesthesiology Classification of Physical Status (ASA)
I- Normal, healthy patient
Describe a patient placed in the 2nd class of the American Society of Anaesthesiology Classification of Physical Status (ASA)
II - A Patient with mild systemic disease e.g. well controlled diabetes or epilepsy,mild asthma.
Describe a patient placed in the 3rd class of the American Society of Anaesthesiology Classification of Physical Status (ASA)
III - A patient with severe systemic disease limiting activity but not incapacitating e.g. Uncontrolled hypertension, recent myocardial infarct
Describe a patient placed in the 4th class of the American Society of Anaesthesiology Classification of Physical Status (ASA)
IV - A patient with incapacitating disease that is a constant threat to life
Describe a patient placed in the 5th class of the American Society of Anaesthesiology Classification of Physical Status (ASA)
V - Moribund patient not expected to live more than 24 hours with or without treatment
Name some dental Contraindications to sedation
Some anterior tooth dentistry difficult with inhalation sedationMulti-rooted endodontics & long procedures not ideal
Why is it not ideal to do long procedures under sedation?
MIDAZOLAM has a short half life and therefore your window for treatment execution is around 20-30 minutes- longer procedures not appropriate for midazolam sedation.
If you have decided a patient s suitable for IV sedation how should you proceed?
- Advise them what is involved and what the alternate options are.2. Let them ask questions, come to an informed decision about the options3. Give them verbal and written instructions4. On the day, check if they have followed the instructions and if anything has changed in MH, SH, etc.
What are the 3 types of sedation?
- Oral 2. Intra venous sedation3. Inhalation Sedation
Name the oral sedation we use
diazepam
Describe the disadvantages of oral sedation
v unpredictable, not reliable, most patients will say it had no effectNo titration of dose to effectOften rapid recoveryMay still need to cannulate
Why is oral sedation unpredictable
Because for different people the drug is metabolised and excreted at a different rate
Describe the advantages of oral sedation
Simple to administerCheapPremed for other sedationCan be very effectivePatient friendly Can be self administered
Which types of patients do we give oral sedation?
Adults & children Special needs patientsNeedle phobicsMild to moderate anxietyPremedication for severe anxiety
Describe the advantages of Inhalation Sedation
Good anxiolytic & sedative propertiesSafe for childrenNo needlesReliable & predictableGood safety record for patientsNo special patient arrangements
How does inhalation sedation work?
We reduce the patients perception of pain to allow them to relax and cooperate during the dental procedure
Describe the disadvantages of Inhalation Sedation
Specialist equipment requiredOccupational side effectsNitrous oxide pollutionClaustrophobia Nasal obstructionRequires psychological ‘back-up’Potential for detrimental action on the reproductive, neurological, haematological, hepatic and renal systemsPossibility of increased cancer risk
Describe the advantages of intravenous Sedation
Non-irritantWide margin of safetyTitratable effectRapid InductionReversibleAmnesiac effect so if procedure is unpleasant they will not remember and patient is unlikely to develop phobia.
Describe the disadvantages of intravenous Sedation
Respiratory depressionParadoxical disinhibitionNo analgesiaPost-op supervisionMonitoring equipmentAmnesiac effect- they have a good experience and cope well they will not remember so phobia isn't cured
What are some environmental factors we need to take into consideration when administering sedation
- Room on Ground Floor 2. Room Protected Entrance Area3. Parking Close By4. Treatment rooms adequate size 5. Recovery room
