Adult Sedation

Question 1

What are the steps we can take to manage a patient in levels of severity?

Answer 1

1. Communication
2. LA
3. Psychological techniques
4. Inhalation sedation
5. IV sedation
6. General anaesthetic

Question 2

Why is there a need for sedation?

Answer 2

1. Theres a high Prevalence of dental anxiety
2. Its Stressful for the dentist to manage anxious patients
3. GDC obligations

Question 3

Define conscious sedation

Answer 3

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.

Question 4

Who needs sedation?

Answer 4

1. needle/ dental phobic
2. Patients who have a strong gag reflex
3. If the dental procedure is especially unpleasant
4. Patients with medical conditions

Question 5

Name some medical conditions that can be

aggravated by the stress of dental treatment

Answer 5

1. Moderate ischaemic heart disease
2. Mild hypertension
3. Mild Epilepsy
4. Mild Asthma

Question 6

Name some medical conditions that can be

affect co coperation

Answer 6

1. Parkinson’s disease
2. Spasticity disorders
3. Mild mental or physical handicap

Question 7

Name some social Contraindications to sedation

Answer 7

1. Alcohol use
2. Drug use
3. Lack of an appropriate adult escort
4. Consent issues
5. Interactions with sedative drugs
6. Not safe

Question 8

Name some medical Contraindications to sedation

Answer 8

1. Severe / uncontrolled / un-investigated systemic disease
2. Medication interactions with sedative agent
3. Allergy to sedative agent
4. Pregnancy
5. Psychosis
6. Respiratory infection

Question 9

What scale do we use to judge a patients Anaesthesiology Classification?

Answer 9

American Society of Anaesthesiology Classification of Physical Status (ASA)

Question 10

Describe a patient placed in the 1st class of the American Society of Anaesthesiology Classification of Physical Status (ASA)

Answer 10

I- Normal, healthy patient

Question 11

Describe a patient placed in the 2nd class of the American Society of Anaesthesiology Classification of Physical Status (ASA)

Answer 11

II - A Patient with mild systemic disease e.g. well controlled diabetes or epilepsy,mild asthma.

Question 12

Describe a patient placed in the 3rd class of the American Society of Anaesthesiology Classification of Physical Status (ASA)

Answer 12

III - A patient with severe systemic disease limiting activity but not incapacitating e.g. Uncontrolled hypertension, recent myocardial infarct

Question 13

Describe a patient placed in the 4th class of the American Society of Anaesthesiology Classification of Physical Status (ASA)

Answer 13

IV - A patient with incapacitating disease that is a constant threat to life

Question 14

Describe a patient placed in the 5th class of the American Society of Anaesthesiology Classification of Physical Status (ASA)

Answer 14

V - Moribund patient not expected to live more than 24 hours with or without treatment

Question 15

Name some dental Contraindications to sedation

Answer 15

Some anterior tooth dentistry difficult with inhalation sedation
Multi-rooted endodontics & long procedures not ideal

Question 16

Why is it not ideal to do long procedures under sedation?

Answer 16

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.

Question 17

If you have decided a patient s suitable for IV sedation how should you proceed?

Answer 17

1. Advise them what is involved and what the alternate options are.
2. Let them ask questions, come to an informed decision about the options
3. Give them verbal and written instructions
4. On the day, check if they have followed the instructions and if anything has changed in MH, SH, etc.

Question 18

What are the 3 types of sedation?

Answer 18

1. Oral
2. Intra venous sedation
3. Inhalation Sedation

Question 19

Name the oral sedation we use

Answer 19

diazepam

Question 20

Describe the disadvantages of oral sedation

Answer 20

v unpredictable, 
not reliable, 
most patients will say it had no effect
No titration of dose to effect
Often rapid recovery
May still need to cannulate

Question 21

Why is oral sedation unpredictable

Answer 21

Because for different people the drug is metabolised and excreted at a different rate

Question 22

Describe the advantages of oral sedation

Answer 22

Simple to administer
Cheap
Premed for other sedation
Can be very effective
Patient friendly 
Can be self administered

Question 23

Which types of patients do we give oral sedation?

Answer 23

Adults & children	
Special needs patients
Needle phobics
Mild to moderate anxiety
Premedication for severe anxiety

Question 24

Describe the advantages of Inhalation Sedation

Answer 24

Good anxiolytic & sedative properties
Safe for children
No needles
Reliable & predictable
Good safety record for patients
No special patient arrangements

Question 25

How does inhalation sedation work?

Answer 25

We reduce the patients perception of pain to allow them to relax and cooperate during the dental procedure

Question 26

Describe the disadvantages of Inhalation Sedation

Answer 26

``` Specialist equipment required Occupational side effects Nitrous oxide pollution Claustrophobia Nasal obstruction Requires psychological ‘back-up’ Potential for detrimental action on the reproductive, neurological, haematological, hepatic and renal systems Possibility of increased cancer risk ```

Question 27

Describe the advantages of intravenous Sedation

Answer 27

``` Non-irritant Wide margin of safety Titratable effect Rapid Induction Reversible Amnesiac effect so if procedure is unpleasant they will not remember and patient is unlikely to develop phobia. ```

Question 28

Describe the disadvantages of intravenous Sedation

Answer 28

``` Respiratory depression Paradoxical disinhibition No analgesia Post-op supervision Monitoring equipment Amnesiac effect- they have a good experience and cope well they will not remember so phobia isn't cured ```

Question 29

What are some environmental factors we need to take into consideration when administering sedation

Answer 29

1. Room on Ground Floor 2. Room Protected Entrance Area 3. Parking Close By 4. Treatment rooms adequate size 5. Recovery room