CF- Reith Special Needs Flashcards
What are characteristics of ideal sedative agent? (9)
- Predictable
- Painless administration
- Immediate
- No side effects
- Immediate Recovery on Demand
- Amnesia for the Duration
- Profound Anxiolysis
- Cheap
- Entirely Pleasant
What are characteristics of N2O? (7)
- Sweet smelling, non irritant colourless gas
- Low blood gas solubility
- Analgesic
- Drug of abuse
- Natually occurring
- Engine performance enhancer
- Greenhouse gas
What are effects of inhalation sedation? (5)
- Analgesic
- Anxiolytic
- Sedative
- Euphoria
- Mood alteration
What is MAC?
Conc needed to prevent movement in 50% of pts in response to pain
* (High MAC = low potency)
* Minimal Alveolar Concentraion
What are indications for N2O? (6)
- Anxious
- Needle phobics
- Gag reflex
- Medically compromised
- Unpleasant procedure (alternative to GA)
- Long appointments
- To improve LA success
What are contraindications for N2O? (8)
- Uncoop
- Blocked airway or pulmonary disease
- MTHFR Deficiency
- Bleomycin therapy
- Recent eye/ear/GI surgery
- Recent head injury
- First trimester of pregnancy
- Psychiatric pts
What are advantages of inhaled sedation? (5)
- Non-invasive
- Easy titration
- Rapid recovery
- Analgesia/anxiolytic/amnesic
- Gag reflex reduced
What are disadvantages of N2O? (6)
- Technique dependent
- Variable amnesia
- Requires psychological support
- Mask coop, obstructs your view
- Nitrous oxide pollution
- Requires constant monitoring + chaperone
How to minimise N2O pollution? (7)
- Active scavenging systems
- Good ventilation
- Floor level extractor fans
- Good mask seal
- Rubber dam
- Minimise pt talking
- Equipment readily checked
How to monitor pt having N2O? (7)
- Assess level of consciousness (verbal response)
- Airway patency
- Respiration
- Skin colour
- Pulse rate
- Blink rate
- Can they keep their mouth open
How to administer N2O?
- 10% N2O for 1 min, then 20%
- Further increments of 5% per min until adequately sedated
- Average flow 5-7L/min
- Max dose: 40-50% N2O
- 100% O2 at end of procedure
What are signs of N2O sedation? (8)
- Verbal communication
- Relaxed
- Decreased response to painful stimuli
- Vitals WNL
- Reduced blink rate
- Mouth remains open
- Pharyngeal reflex reduced
- Laryngeal reflex intact
What are symptoms of N2O sedation? (5)
- Relaxed
- Paraesthesia
- Euphoria
- Warmth (vasodilation)
- Indifference to passage of time
What are features of oversedation? (5)
Persistent mouth closing
Spontaneous mouth breathing
Unpleasant feelings
Uncooperation
Nausea/vomitting
What to check before discharge of pt having N2O? (4)
- Assess fitness to leave - walk/balance unaided
- Ask if they feel okay to leave
- 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? (8)
- ASA I or II
- Good airway
- Able to tolerate cannulation
- No allergies to benzos
- Age >16
- Carer available
- Able to consent
- Not pregnant
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? (5)
- Anxiolytic
- Amnesia
- Anticonvulsant
- Sedative
- Respiratory depression
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
Features of Dental Phobia
- Anxiety response that leads to avoidance or endurance with distress
- Pt recognizes fear is disproportionate
- Persistent (>6 mo)
- Interferes with normal life
Features of Dental Phobia (4)
- Anxiety response that leads to avoidance or endurance with distress
- Pt recognizes fear is disproportionate
- Persistent (>6 mo)
- Interferes with normal life
What is conscious sedation?
Drug induced depression of consciousness where pts are able to respond to verbal commands
- Safe enough to render loss of consciousness unlikely
Disabilities associated with CP (4)
- Intellectual disability
- Vision and hearing disabilities
- Epilepsy
- Speech
Features of ASD (5)
- Genetic+environmental cause
- Spectrum
- Intellectual deficit
- Sensory problems
- Triad (poor social skills, communication, routines)
