Assessment for IV Sedation

Question 1

What sedation guidelines should we refer to for dentistry in Scotland?

Answer 1

• Standards for Conscious Sedation in the Provision of Dental Care (2015)
• SDCEP Conscious Sedation in Dentistry (2017)

Question 2

What are some key points that apply to the assessment visit for sedation or GA?

Answer 2

• done on separate visit to treatment
• good clear communication
• pleasant surroundings and staff
• promptness
• should pay attention to patients physiology, pathology & psychology
• it is essential to have a assessment visit prior to treatment under sedation/GA

Question 3

What information do we require as part of the sedation assessment?

Answer 3

• History
• Examination
• Treatment plan
• Consent
• Information for patient & escort

Question 4

What parts of anxious social history must we investigate at the assessment stage for sedation?

Answer 4

• nature of fear/anxiety
• is the anxiety general or specific
• can use MDAS if you want

Question 5

What areas of social history are important to investigate at the assessment stage of sedation?

Answer 5

• occupation
• anxiety
• escort *** (essential)
• alcohol
• responsibilities (e.g children)
• transport
• age (extremes of age)

Question 6

What areas of dental history are important to investigate at the assessment stage of sedation?

Answer 6

• referral source
• previous bad experiences?
• previous sedation / GA
• symptoms (acute or chronic)
• proposed procedure (can it be completed within 45 mins?)

Question 7

What areas of drug history are important to investigate at the assessment stage of sedation?

Answer 7

• drugs they are taking
• drug allergy
• previous anaesthetic
• recreational drug use

Question 8

How do drugs tend to affect midazolam?

Answer 8

Almost all drugs increase sedative effect of midazolam

Question 9

Give some examples of things that would place a patient in the ASA II category:

Answer 9

• current smoker
• pregnancy
• well-controlled epilepsy
• well-controlled diabetes
• BP = 140-159/90-94
• obesity (BMI = 30 but <40)

Question 10

Give some examples of things that would place a patient in the ASA III category:

Answer 10

• insulin dependent diabetes
• > 6 months post MI
• > 6 months post CVA
• stable angina
• COPD
• BP = 160-199/95-114
• BMI > 40

Question 11

Give some examples of things that would place a patient in the ASA IV category:

Answer 11

• unstable angina
• <3 months post MI
• <3 months post CVA
• severe COPD
• BP > 200/115

Question 12

Who can we treat in primary care based on ASA classification?

Answer 12

ASA I & II

Question 13

Which patients are treated via secondary care based on ASA classification?

Answer 13

ASA III & IV

Question 14

How do sedative agents affect patients with respiratory disease?

Answer 14

Almost all sedative agents cause respiratory depression, so worsen respiratory disease

Question 15

what are pharmacodynamic interactions?

Answer 15

Interactions between drugs which have similar or antagonistic effects
- quite predictable

Question 16

Give examples of pharmacodynamic interactions for benzodiazapines:

Answer 16

• antidepressants
• antihypertensives

Question 17

What are pharmacokinetic interactions?

Answer 17

One drug alters the absorption, distribution, metabolism or excretion of another
- increases or reduces the amount of drug available
- not predictable

Question 18

Why is pregnancy a risk for sedation?

Answer 18

• potential sedative effect on baby
• sedative agents excreted in breast milk

Question 19

what vita signs should you record at the sedation assessment visit?

Answer 19

• HR
• BP
• oxygen saturation
• BMI = weight/height

Question 20

what is the working time we have under sedation? what does this affect?

Answer 20

45 minutes
- avoid overly complex treatment

Question 21

How are patients orientated to the sedation clinic?

Answer 21

• written pre & post op instructions
• introduction to environment & staff
• opportunity for questions
• consent
• appointment ASAP after assessment