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Conscious Sedation I > Chapter 14: Inhalation Sedation Equipment > Flashcards

Chapter 14: Inhalation Sedation Equipment Flashcards

1
Q

What does the primary equipment consist of?

A

a supply of gases and an apparatus for their delivery to the patient

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2
Q

the modern inhalation sedation unit is…

A

A compact, continuous-flow machine used for the administration of compressed gases under controlled conditions

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3
Q

What’s the primary difference between machines used to administer inhalation general anesthesia and the modern inhalation sedation unit?

A

the first can deliver a number of inhalation anesthetic agents whereas the second has been altered to deliver only two gases: N2O and O2

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4
Q

What are the two basic types of inhalation sedation units?

A

1) continuous flow machine

2) intermittent- or demand-flow unit

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5
Q

What kind of inhalation sedation unit is no longer used in North America?

A

the demand-flow unit

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6
Q

What kind of inhalation sedation unit is more popular and recommended for use in dentistry?

A

continuous-flow unit

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7
Q

What is the demand-flow type of inhalation sedation compared to?

A

SCUBA (self-contained underwater breathing apparatus) divers (it operates on the same principles)

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8
Q

How does the demand-flow type of N2O-O2 inhalation sedation unit work?

A

it does not deliver gas continuously to the patient but varies the rate and volume of delivered gas according to the patient’s respiratory demands and requirements

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9
Q

What is one major advantage of demand-flow units?

A

the economy obtained from decreased volume of compressed gases used

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10
Q

Two primary disadvantages of demand-flow units?

A

1) the volume flow of anesthetic gases per minute is not visible or registered anywhere on the machine. instead there is a dial on which the percentages of the gases delivered are recorded and another on which the percentages of the gases delivered are recorded and another on which the pressure at which they are delivered is visible. the LACK of ability to visually monitor the flow of gases to the patient is a MAJOR disadvantage of the demand flow unit
2) lack of accuracy if the mixer valve. the percentage of gas delivered is not accurate over the full range of delivery

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11
Q

Name a demand-flow unit that is used in the hospital and ambulatory setting and why it’s used

A

Nitronox; the percentage is NOT adjustable (fixed at 50% O2/N2O) and extremely accurate. in dentistry as practiced in North America, this type of unit would fall below the standard of care because it prevents the important practice of titration from occurring.

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12
Q

Preoperative unit preparation

A

Equipment
Flowmeters
Scavenging masks
Vacuum system

O2 gauge will give an accurate indication of the amount of gas in the tank
N2O will read about 750 psi until nearly empty
If no O2 the machine will be nonfunctional

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13
Q

Patient participation?

A

Baseline vitals? - yes for adults, not for kids
Select flow 6-7 l/min (adult), 4-5 l/min (kids)…bag about 2/3 full
100% initially
Place nasal hood

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14
Q

Calculation of concentrations of administered gases:

Q: 3 N2O, 5 O2 = what % of Nitrous?

A

37.5%

3+5 = 8
3/8 = 37.5%
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15
Q

N2O/O2 administration technique using titration

A

Begin with 10% N2O or 1L/min N2O
Increase by 5% or .5L/min q 1-3 min
When sedation is evident wait longer between N2O increases when desired level of sedation is near

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16
Q

What do you do when you’re done?

A

100% O2 for 5 min
If patient experiences lethargy, dizziness, or lightheadedness continue 100% O2

Nedley’s Notes: 5 mins is an arbitrary time

Washout period Is around 190 seconds…3 mins (some article…check it out)

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17
Q

Principles of Recovery from N2O/O2

A

Exhaled unchanged from the lungs
Postoperative symptoms like lethargy, dizziness, nausea
Postoperative O2 is necessary for a minimum of 5 min and maybe longer

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18
Q

Technique for assessing adequate recovery

A

Postoperative vital signs
BP w/in 10mm Hg for systolic and diastolic
HR w/in 10 bpm
RR w/in 5 rpm
**Patient is alert and oriented, vitals are near baseline

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19
Q

Assessing recovery from N2O/O2

A 
Assessment begins following 5 min O2
Postoperative vital signs
? Patient regarding lethargy, headache, dizziness, confusion, nausea
If symptoms present continue O2
Dismiss when assured of full recovery
Recommend an escort if necessary
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20
Q

Guidelines for patient discharge following moderate sedation according to the ASA practice guidelines for sedation and analgesia by non-anesthesiologists

A
  • patient should be alert and oriented
  • vital signs should be stable and within acceptable limits
  • postoperative instructions regarding diet, medications, activities, and an emergency contact number given to patient or their escort
  • documentation of adequate recovery must be maintained for each patient visit
21
Q

what is a continuous flow unit and describe their main advantage and disadvantage?

A

these units contain flowmeters and are characterized hy the continuous flow of gases, regardless of the respiratory pattern of the patient. gas continues to be delivered through the machine even as the patient exhales. whereas continuous flow-machines use a greater volume of gas over a given period of time than the demand flow unit, this minor disadvantage is more than compensated for by the significantly greater accuracy and safety of continuous flow units.

22
Q

what’s in a gas circuit used in the typical continuous flow unit? 6 items

A

1) gas cylinders
2) reducing valves
3) flowmeters
4) reservoir bag
5) conducting tubing
6) nasal hood

23
Q

all inhalation sedation units contain which same basic components? 7 items

A

1) compressed gas cylinders
2) reducing valves (regulators)
3) pressure gauges
4) flowmeters
5) reservoir bag
6) conducting tubing
7) full face mask, nasal hood, o1r nasal cannula

24
Q

Portable System - what is it? where is it used?

A

rolling stand compressed gas cylinders are attached to the inhalation sedation unit at the yoke assembly. this system is used in offices where the frequency of N2O-O2 use is LOW or in situations in which the EXPENSE of a central storage system is prohibitive

25
Q

What kind of cylinders do portable systems use?

A

“E” cylinders - they’re smaller compressed gas cylinders - which consequently require replacement more frequently

26
Q

What kind of cylinders do central systems use?

A

than the larger “G” and “H” cylinders

27
Q

when and where are central systems used?

A

it’s most advantageous in offices that use inhalation sedation on a more regular basis. the greater initial cost of a central storage system is quickly made up in savings obtained from the use of the larger gas cylinders

28
Q

what is the central storage system with mobile heads?

A

it represents a compromise between the portable and central storage systems, the central storage system with mobile heads permits the use of LARGER compressed gas cylinders…whereas the inhalation sedation unit sits on a portable stand (without the yoke apparatus), which may be moved from treatment area to treatment area as the needed for inhalation sedation arises. Quick-connect tubing attaches the unit to the O2 and N2O outlets onthe wall in each treatment area.

This system is recommended for offices in which the economics of central storage warrant its installation but the frequency of use of inhalation sedation does not justify the purchase of heads for all treatment areas.

One head may be used throughout the office, with others added to the system as increased demand dictates.

29
Q

What are the cylinders used to store and transport compressed gases manufactured from and what is its thickness?

A

3/8 inch thick steel. some cylinders of N2O have been made from aluminum

30
Q

how often do the integrity of all compressed gas cylinders have to be tested in accordance with DOT regulations? and how is the testing performed?

A

every 5 years; by internal hydrostatic pressure (the pressure to which the cylinder is tested based on the size of the cylinder)

31
Q

What are the biggest and smallest sizes of cylinders?

A

“A” is the smallest, “HH” is the largest

32
Q

Which cylinders are used in inhalation sedation?

A

“E”, “G”, and “H”.

“E” are used for both N2O and O2 in portable units whereas larger cylinders in central storage are “G” for N2O and “H” for O2

33
Q

Colors for N2O vs. O2?

A

N2O - blue; O2 - green

34
Q

N2O Cylinder and its contents

A
  • N2O present in both liquid and gaseous states
  • filled 90% to 95% capacity with liquid N2O
  • above the liquid is N2O gas
  • pressure at 750 psig at 25C (70F) within both E and G cylinders
35
Q

how many gallons does one ounce of of N2O liquid provide?

A

3.88 gallons

36
Q

A full E cylinder of N2O produces approximately ____ L of gaseous N2O at sea level and room temperature, whereas the larger H cylinder provides approximately ______L of N2O gas

A

1600 L; 16,000 L

37
Q

How does the N2O respond over time when used?

A

because of the presence of liquid N2O in the cylinder, the gas pressure gauge on the cylinder will record “full” (approx 750 psig) as long as any liquid remains in the cylinder. the pressure of the N2O vapor floating above the liquid N2O is 750 psig. As the gaseous N2O exits from the cylinder, liquid N2O vaporizes to replace it. The pressure of this “new” gas is 750 psig. This process continues until no more liquid remains to replace the gas. Then it’ll act like an O2 gauge and the pressure gauge will fall in relation to the pressure of gase remaining.

38
Q

In normal clinical usage of inhalation sedation…how many O2 cylinders are used for every N2O cylinder of the same size?

A

2.5 O2 cylinders for every 1 N2O cylinder

39
Q

in central storage systems, what is the minimum number of cylinders you should have for N2O and O2?

A

no fewer than 2 H cylinders of O2 and one G cylinder of N2O.

40
Q

in portable storage systems, what is the minimum number of cylinders you should have for N2O and O2?

A

one or two E cylinders of N2O and two E O2 cylinders

41
Q

what is a manifold?

A

it joins multiple compressed gas cylinders. 12 N2O cylinders may be attached to a single manifold.

42
Q

what are regulators or reducing valves?

A

they are located between the compressed gas cylinder and the flowmeter. in central storage, they are commonly placed on the cylinder itself. they function to maintain a constant gas pressure to flowmeters and to the patient regardless of the pressure of gas contained within the cylinder.

43
Q

reservoir bags size, material and most common size used in dentistry?

A

bladder-type bags, made of latex-free material or silicone, ranging in size from 1 L to 8 L. the 3 L reservoir bag is the most frequently used in dentistry

44
Q

why is a reservoir bag important in GA?

A

because during this time the patient is unconscious and unable to respond to the commands of the anesthesiologist.

should spontaneous respiration cease, controlled respiration can be started, with the anesthesiologist squeezing the reservoir bag once every 5 seconds for an adult, and every 3 seconds for the child and infant

45
Q

what the reservoir bag called in the past?

A

rebreathing bag

46
Q

what is another name for a conducting tube and what does it connect to?

A

is breathing tube; it connects the bag-tee to the nasal hood

47
Q

minimum O2 percentage is ___ (some units provide a minimum of ___%, others 50%)

A

30%, 25%

48
Q

quick connect for positive-pressure oxygen

A

all inhalation sedation units have a quick-connect attachment for positive-pressure O2 located on the head

Conscious Sedation I (9 decks)

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