assessment for sedation

Question 1

What are the parts of a sedation assessment?

Answer 1

History - social, dental, medical
Examination - general, oral and vital signs
Treatment plan
Consent
Information for patient and escort

Question 2

Name 4 parts of the social history for a sedation assessment

Answer 2

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

Question 3

Name 4 parts of the dental history for a sedation assessment

Answer 3

Any from:
- referral source
- if previous bad experience
- any previous sedation/GA experience
- the proposed procedure
- patients symptoms

Question 4

Describe a medical history for sedation assessment

Answer 4

MH as with any other patient
Emphasis on drug history and allergies
Always check drugs in BNF
Recreational drug use

Question 5

Why is a drug history important?

Answer 5

Almost all drugs increase the sedative effect of midazolam

Question 6

What is ASA classification I?

Answer 6

Normal healthy patient, non-smoker, minimal alcohol

Question 7

What is ASA classification II?

Answer 7

Mild systemic disease

Question 8

What is ASA classification III?

Answer 8

Severe systemic disease; limits capacity but not incapacitating

Question 9

What is ASA classification IV?

Answer 9

Severe systemic disease; constant threat to life

Question 10

What is ASA classification V?

Answer 10

Moribund; not expected to live >24 hours

Question 11

What is ASA classification VI?

Answer 11

Patient who is brain dead for organ donation

Question 12

What ASA classifications can be treated in primary and secondary care?

Answer 12

ASA I and II - primary care
ASA III and IV - secondary care

Question 13

What ASA classification do pregnant women fall under?

Answer 13

ASA II

Question 14

How does having a psychiatric disease affect sedation?

Answer 14

Patients are more difficult to treat

Question 15

What are pharmacodynamic interactions?

Answer 15

Interactions between drugs which have similar or antagonistic pharmacological effects
Predictable from pharmacology

Question 16

What are pharmacokinetic interactions?

Answer 16

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

Question 17

Give 2 examples of pharmacodynamic interactions?

Answer 17

Benzodiazepines and antidepressants
Benzodiazepines and antihypertensives

Question 18

Name 4 things to look out for during general examination of a patient

Answer 18

Signs of anxiety
Discomfort with surroundings
Eye contact
Speech

Question 19

What vital signs are measured in a sedation assessment?

Answer 19

Heart rate
Blood pressure
Oxygen saturation
BMI

Question 20

Give 4 examples of good practice for patient orientation during a sedation assessment?

Answer 20

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