CF- Reith Special Needs Flashcards
What are characteristics of ideal sedative agent?
- Predictable in its Action
- Painless in Administration
- Immediate Onset
- Entirely Pleasant to the Patient
- No side effects
- Immediate Recovery on Demand
- Amnesia for the Duration
- Profound Anxiolysis
- Inexpensive
What are characteristics of N2O?
- Sweet smelling, non irritant colourless gas
- Natually occurring
- Produces analgesia
- Weak anaesthetic
- Low blood gas solubility
- Drug of abuse
- Engine performance enhancer
- Greenhouse gas
What are effects of inhalation sedation?
- Sedation
- Anxiolysis
- Mood alteration
- Euphoria
- Analgesia
What is MAC?
Alveolar concentration needed to prevent movement in 50% of pts in response to pain (High MAC = low potency)
What are indications for N2O?
- Anxious adults and children
- Needle phobia
- Gag reflex
- Medically compromised
- Unpleasant procedure (alternative to GA)
- To improve LA success
What are contraindications for N2O?
- Uncooperative/uncommunicative pt
- Blocked airway
- Serious pulmonary disease
- Recent eye/ear/GI surgery
- Recent head injury
- First trimester of pregnancy
- Serious psychological disorders
What are advantages of inhaled sedation?
- Non-invasive
- Drug level easily altered or disocontinued
- Excreted via lungs with rapid recovery
- Some analgesia
- Gag reflex obtunded
What are disadvantages of N2O?
- Technique dependent
- Requires pyscholoigcal support
- Variable amnesia
- Route of administration close to operating site
- Nitrous oxide pollution
How to minimise N2O pollution?
- Active scavenging systems
- Good ventilation
- Floor level extractor fans
- Good mask seal
- Minimise pt talking
- Use of rubber dam
- Equipment readily checked
- 100% O2 at end of procedure
How to monitor pt having N2O?
- Assess level of consciousness (verbal response)
- Airway patency
- Respiration
- Skin colour
- Capillary refill
- Pulse rate
- Rhythm and volume
How to administer N2O?
- 10% N2O for 1 min, then 20%
- Further increments of 5% per min until adequately sedated
- Averalge flow 5-7L/min
- Usualy dose range 20-50% N2O
- 100% O2 at end of procedure
What are signs of N2O sedation?
- Pt awake with verbal communication
- Pt relaxed and comfortable
- Pulse, BP, RR WNL
- Reduced blink rate
- Mouth remains open on request
- Protective reflexes are maintained (cough)
- Gag reflex reduced
- Decreased response to painful stimuli
- General decrease in movements
What are symptoms of N2O sedation?
- Relaxed, comfortable
- Pain severity decreased
- Paraesthesua/tingling in fingers/toes
- Lethargy
- Euphoria
- Detachment
- Warmth (vasodilation)
- Indifference to passage of time
What are features of oversedation?
Persistent mouth closing
Spontaneous mouth breathing
Pt complains of unpleasant feelings
Lack of cooperation
Nausea/vomitting
What to check before discharge of pt having N2O?
- Assess fitness to leave
- Ask if they feel okay to leave
- Walk and balance unaided
- Written post-sedation instructions
- Clinical records
What are indications for IV sedation?
- Anxiety
- Conditions made worse by anxiety (angina, asthma)
- To prevent dental phobia
- To avoid GA
- Special needs
What are advantages of IV sedation?
- Rapid sedation
- Good pt cooperation
- Amnesia
What are disadvantages of IV sedation?
- Respiratory depression
- Disinhibition effects
- Post operative supervision required
What are referral criteria for IV sedation?
- ASA I or II
- Good airway
- No allergies to benzos
- BMI <40
- Age >16 (caution > 65)
- Suitable escort and carer available
- Able to consent
- Able to communicate during tx
- Not pregnacnt
- No movement disorders that would compromise safe dental tx
- Able to tolerate cannulation
- Recreational drug use may influence tx
Why is midazolam a common IV and oral sedation agent? What is the reversal agent?
- Wide safety margin
- Reversal agent- Flumazenil
What are actions of benzos?
- Anxiolytic
- Sedative
- Amnesia
- Central muscle relaxant
- Respiratory depression
- Anticonvulsant
- Disinhibition
What are post sedation instructions for IV sedation?
- No driving
- Escort for 8 hours
- Not to sign important documents
- Not to use machinery
- No alcohol
- Tx information
