Assessment for Sedation / GA

Question 1

when assessing for sedation / GA

Answer 1

separate visit
physiology, pathology, psychology
essential to prerequisite tx for pt & dental team
good clear communication
promptness
pleasant staff & surroundings

Question 2

social hx

Answer 2

nature of fear
is it phobia or anxiety
general v specific
anxiety questionnaire
occupation
escort
alcohol
responsibilities i.e. children
ages (extremes of age)

Question 3

dental hx

Answer 3

referral source i.e. own GDP
prev bad experience
previous sedation / GA & if there were any issues
symptoms - acute / chronic
proposed procedure - completed in 45mins

Question 4

medical hx

Answer 4

specific emphasis on drug hx, drug allergies, previous anaesthesia / sedation, recreational drug use

Question 5

drugs increasing sedative effect of midazolam

Answer 5

almost all esp:
alcohol
opioids
erythromycin
antidepressants, antihistamines, antipsychotics
recreational drugs

Question 6

impact of sedation on respiratory disease

Answer 6

almost all sedative agents cause respiratory depression
normally able to compensate
but ask how well managed it is & what medication they are on & if they have been hospitalised for it etc

Question 7

pharmacodynamic interactions

Answer 7

interactions between drugs which have similar or antagonistic pharmacological effects or side effects
predictable from pharmacology:
antidepressants + BDZ’s
antihypertensives + BDZ’s

Question 8

pharmacokinetic interactions

Answer 8

one drug alters the absorption, distribution, metabolism or excretion of another thereby increasing or decreasing the amount of drug available to produce its pharmacological effects
not predictable and only affects a small proportion of cases

Question 9

orientation to sedation setting

Answer 9

written pre & post op instructions
introduction to environment & staff
opportunity to ask questions
consent
appt soon after assessment if possible