Assessment for IV Sedation Flashcards
What sedation guidelines should we refer to for dentistry in Scotland?
- RCS Standards for Conscious Sedation in the Provision of Dental Care (2015)
- SDCEP Conscious Sedation in Dentistry (2017)
What are some key points that apply to the assessment visit for sedation or GA?
- 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
What information do we require as part of the sedation assessment?
- History
- Examination
- Treatment plan
- Consent
- Information for patient & escort
What parts of anxious social history must we investigate at the assessment stage for sedation?
- nature of fear/anxiety
- is the anxiety general or specific
- can use MDAS if you want
What areas of social history are important to investigate at the assessment stage of sedation?
- occupation
- anxiety
- escort (essential)
- alcohol
- responsibilities (e.g children)
- transport
- age (extremes of age)
What areas of dental history are important to investigate at the assessment stage of sedation?
- referral source
- previous bad experiences?
- previous sedation / GA
- symptoms (acute or chronic)
- proposed procedure (can it be completed within 45 mins?)
What areas of drug history are important to investigate at the assessment stage of sedation?
- drugs they are taking
- drug allergy
- previous anaesthetic
- recreational drug use
How do drugs tend to affect midazolam?
Almost all drugs increase sedative effect of midazolam
Give some examples of things that would place a patient in the ASA II category:
- current smoker
- pregnancy
- type II diabetes
- well-controlled epilepsy
- well-controlled asthma
- BP = 140-159/90-94
- obesity (BMI = 30 to <40)
Give some examples of things that would place a patient in the ASA III category:
- insulin dependent diabetes (type I)
- > 6 months post MI
- > 6 months post CVA
- stable angina
- COPD
- BP = 160-199/95-114
- BMI > 40
Give some examples of things that would place a patient in the ASA IV category:
- unstable angina
- <3 months post MI
- <3 months post CVA
- severe COPD
- BP > 200/115
Who can we treat in primary care based on ASA classification?
ASA I & II
Which patients are treated via secondary care based on ASA classification?
ASA III & IV
How do sedative agents affect patients with respiratory disease?
Almost all sedative agents cause respiratory depression, so worsen respiratory disease
what are pharmacodynamic interactions?
Interactions between drugs which have similar or antagonistic effects
- quite predictable
