assessment for IV Sedation Flashcards
what is the GDC definition of sedation
- “a technique in which the use of a drug or drugs produces a state of depression of the CNS enabling treatment to be carried out,
- but during which communication can be maintained and the modification of the patient’s state of mind is such that the patient will respond to command throughout the period of sedation.
Techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely”
- but during which communication can be maintained and the modification of the patient’s state of mind is such that the patient will respond to command throughout the period of sedation.
what is involved in sedation assessment
- A full assessment that confirms the treatment required, whether sedation is needed and the preferred technique
Sedation assessment also involves informed consent and the provision of information to the patient which aims to ensure treatment and aftercare are as safe as p
in what 2 ways should the patient be assessed before sedation
- A full assessment that confirms the treatment required, whether sedation is needed and the preferred technique
Sedation assessment also involves informed consent and the provision of information to the patient which aims to ensure treatment and aftercare are as safe as possible
in what 2 ways should the patient be assessed before sedation
Sedation assessment form
Patients for GA attend for pre-assessment in the day surgery unit or hospital and this is carried out by a nurse
can the assessment be carried out on the same day as sedation treatment
no
what is included in the assessment
- History
○ Social
○ Dental
○ Medical- Examination
○ General
○ Oral
○ Vital signs - Treatment Plan
- Consent
Information for patient and escort
- Examination
what elements of a patients social history are relevant for sedation
- Nature of fear
- Anxiety questionnaire
- Occupation
○ Try and determine whether patient can return to work the next day after having sedation but this also depends on what treatment is carried out
§ Eg patient had 4 wisdom teeth removed; wouldn’t recommend they return to work the next day as they will be sore and swollen - Escort
○ Mandatory
○ Need to stay in the building with patient while they are having treatment
○ Need to take the patient home after treatment and stay with them at home until the sedation has worn off - Alcohol
○ Normal alcohol intake - Responsibilities
○ Eg children
○ Elderly relatives need taken care of?
○ Need other measures put into place - Transport
○ Public transport / own transport / taxi - Ages
Extremes of age
recreational drugs taken?
what elements of a patients dental history are relevant for sedation
- Referral source
○ Eg own GDP- Previous bad experience
○ Are they anxious about all treatment or something specific - Previous sedation / GA
○ Any problems
§ Eg if they had GA did it take ages for the patient to wake up - Symptoms
○ Acute
○ Chronic - Proposed procedure
○ Completed within 45 minutes
§ Can top sedation up but it is usually unadvisable to do this
○ Difficult to tolerate
§ Eg some 3rd molars
Ie these patients might usually be perfectly happy to have treatment to be carried out but the procedure means it is causing problems
- Previous bad experience
what elements of a patients medical history are relevant for sedation
fill out MH form
get more information about conditions / on-going treatment / etc
always check drugs - BNF
- drug history
- drug allergy
what effect does almost all drugs have in terms of interaction with midazolam
Almost all drugs increase the sedative effect of midazolam
name drugs which can cause this increase sedative effect of midazolam
○ Alcohol
○ Opiods
○ Erythromycin
○ Antidepressants, antihistamines, antipsychotics
Recreational drugs
what is ASA I
○ Normal healthy patient
○ Non-smoker
○ Minimal alcohol
No medication
what is ASA II
○ Mild systemic disease
○ Current smoker
○ Pregnancy
○ Well-controlled epilepsy
○ Well controlled asthma
○ NIDDM = non-insulin dependent diabetes mellitus
○ BP = 140-159 / 90-94
§ Borderline hypertension
Obesity (BMI: 30-<40)
what is ASA III
Severe systemic disease
Limits activity but not incapacitating
○ IDDM = insulin dependent diabetes mellitus
○ >6/12 (ie more than 6 months) post MI
○ >6/12 post CVA / stroke
○ Stable angina
○ COPD
○ BP = 160-199 / 95 -114
§ Hypertension
○ BMI: >40
Morbidly obese
what is ASA IV
Severe systemic disease
Constant threat to life
○ Unstable angina
§ Has chest pain at rest
○ <3/12 post MI or stenting
○ <3/12 post CVA
○ Severe COPD
○ BP > 200 / 115
Very hypertensive