assessment for sedation Flashcards
What are the parts of a sedation assessment?
History - social, dental, medical
Examination - general, oral and vital signs
Treatment plan
Consent
Information for patient and escort
Name 4 parts of the social history for a sedation assessment
Any from:
- natures of fears, anxiety or phobia
- anxiety questionnaire
- occpuation
- escort
- alcohol consumption
- smoking status
- responsibilities eg - children
- transport
- age if extremes of age
Name 4 parts of the dental history for a sedation assessment
Any from:
- referral source
- if previous bad experience
- any previous sedation/GA experience
- the proposed procedure
- patients symptoms
Describe a medical history for sedation assessment
MH as with any other patient
Emphasis on drug history and allergies
Always check drugs in BNF
Recreational drug use
Why is a drug history important?
Almost all drugs increase the sedative effect of midazolam
What is ASA classification I?
Normal healthy patient, non-smoker, minimal alcohol
What is ASA classification II?
Mild systemic disease
What is ASA classification III?
Severe systemic disease; limits capacity but not incapacitating
What is ASA classification IV?
Severe systemic disease; constant threat to life
What is ASA classification V?
Moribund; not expected to live >24 hours
What is ASA classification VI?
Patient who is brain dead for organ donation
What ASA classifications can be treated in primary and secondary care?
ASA I and II - primary care
ASA III and IV - secondary care
What ASA classification do pregnant women fall under?
ASA II
How does having a psychiatric disease affect sedation?
Patients are more difficult to treat
What are pharmacodynamic interactions?
Interactions between drugs which have similar or antagonistic pharmacological effects
Predictable from pharmacology
What are pharmacokinetic interactions?
One drug alters the absorption, distribution, metabolism or excretion of another
This increases or reduces the amount of drug available to produce its pharmacological effect
Not predictable and only effects a small number of cases
Give 2 examples of pharmacodynamic interactions?
Benzodiazepines and antidepressants
Benzodiazepines and antihypertensives
Name 4 things to look out for during general examination of a patient
Signs of anxiety
Discomfort with surroundings
Eye contact
Speech
What vital signs are measured in a sedation assessment?
Heart rate
Blood pressure
Oxygen saturation
BMI
Give 4 examples of good practice for patient orientation during a sedation assessment?
Any from:
- give the patient written pre- and post-operative instructions
- introduce the patient to the environment and staff
- give the opportunity for questions
- get consent
- make the appointment soon after the assessment if possible
