assessment key points

Question 1

GDC definition

Answer 1

drug(s)
state of depression of CNS
enabling tx
communication can be maintained
will respond to command (verbal/normal method)
margin of safety wide enough to render unintended LOC unlikely
retains protective reflexes

Question 2

guidelines

Answer 2

standards for CS in the provision of dental care 2015

SDCEP CS in Dentistry 2017

Question 3

SH

Answer 3

nature of fear
phobia vs anxiety
general vs specific
anxiety questionnaire e.g. MDAS
occupation
escort
alcohol
responsibilities e.g. children
transport
age (extremes)

Question 4

DH

Answer 4

referral source e.g. GDP
prev bad experience
prev sedation/GA - any problems?
symptoms - acute/chronic
proposed procedure
 - completed within 45mins (IV)

Question 5

purpose of assessment visit

Answer 5

confirm tx
whether sedation needed
preferred technique
informed consent
info to pt - written

separate visit mandatory

Question 6

assessment

Answer 6

history
exam
 - general, oral, height and weight, vital signs
tx plan
consent
info for pt and escort

Question 7

MH

Answer 7

drug history
recreational drug use
almost all drugs increase sedative effect of midazolam

Question 8

ASA1

Answer 8

normal healthy pt
non-smoker
minimal alcohol

Question 9

which pts can be seen in primary care?

Answer 9

ASA 1 and 2

Question 10

ASA2

Answer 10

mild systemic disease
obesity 30-40
current smoker
pregnancy
well-controlled epilepsy/asthma
NIDDM
borderline hypertension

Question 11

ASA3

Answer 11

severe systemic disease, limits activity but not incapacitating
IDDM
>6/12 post MI/CVA
stable angina
COD
BMI >40
uncontrolled diabetes
severe asthma

Question 12

ASA4

Answer 12

severe systemic disease, constant threat to life
unstable angina (pain at rest)
<3/12 post MI/CVA/stenting
severe COPD

Question 13

ASA5

Answer 13

moribund, not expected to live >24hrs

Question 14

ASA6

Answer 14

pt who is brain dead for organ donation

Question 15

sedation and resp disease

Answer 15

almost all sedative agents cause respiratory depression

Question 16

Qs to ask about asthma?

Answer 16

drugs? freq?
hospitalised?
exacerbated by stress?

Question 17

pharmacokinetic interactions

Answer 17

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

Question 18

pharmacodynamic interactions

Answer 18

interactions between drugs which have similar/antagonistic pharmacological effects or SEs
predictable from pharmacology

Question 19

pregnancy

Answer 19

theoretical risks
? teratogenic
? sedative effect on baby
? lactation

avoid if possible

Question 20

vital signs and monitoring

Answer 20

before and every 5mins during
pulse
bp
O2 sats
visual monitoring
sedation score

Question 21

BMI cut off for IV

Answer 21

35

Question 22

general exam

Answer 22

signs of anxiety
discomfort with surroundings
eye contact
speech
vital signs

Question 23

tx planning

Answer 23

avoid overcomplicated tx - good working time 45mins
realistic
deal with misconceptions re sedation
- LOC/amnesia
- lack of control - emphasise they can still ask you to stop,
they are in control