Chapter 16: Inhalation Sedation: Complications Flashcards
What can cause oversedation?
combining N2O-O2 with one or more other sedative agents if the N2O is not titrated
what are the most common complications of inhalation sedation?
1) inadequate or incomplete sedation
2) poor patient experience
3) equipment performance
which personality type has a more difficult time with inhalation sedation?
authoritarian type - who when faced with the prospect of the loss of control or the sense of this loss becomes uncomfortable. inadequate or incomplete sedation usually involves poor patient selection for the use of N2O-O2 sedation.
Patient types that might not do well with N2O-O2:
- patients who are emotionally and psychologically unstable
- patients who use mind-altering drugs (may have residual conflicting or counterproductive effects from N2O administration)
- hyporesponders (representing 15% of the population, may not respond to the highest levels of N2O -70%)
- severely fearful patients
signs and symptoms of oversedation
excessive perspiration, nausea, vomiting, hallucations, and increased agitation rather than sedation
when do complications usually arise?
when using a higher concentration of N2O than is required by the patient (lack of titration) and long duration of use (greater than 1 hour)
the most common cause of nausea and vomitting during dental treatment is…
the inadvertent swallowing of blood (incidence of N&V with N2O-O2 is extremely low)
How often does N&V occur in patients?
in fewer than 0.5% of patients
food and N2O
a heavy meal or on a near empty stomach can cause N&V in pediatric patients
“roller coaster ride”
increasing, decreasing, increasing and decreasing N2O-O2 flow. titration is encouraged but wide swings can have a deleterious effect on the patient
why is there tooth pain associated with sinus pressure?
because the anterior, middle, and posterior superior alveolar nerves pass through the sinus membrane, the increased pressure within the sinus cavity on the nerve(s) can lead to the feeling of a toothache. increased sinus pressure can cause a patient to experience “aching” in maxillary teeth and is usually associated with prolonged use (>1 hour) of N2O-O2. This increased pressure can, on rare occasion, lead to earache as pressure increases within the inner ear cavity.
vertigo and N2O-O2
prolonged exposure of the vestibulocochlear complex to N2O can cause increased tension on the tympanic membrane. this tension can result in an alteration in hearing acuity, and the patient may complain of this alteration in hearing
contact lens wearers and N2O-O2
the nasal mask, if not placed snugly over the nose, will potentially allow the dry gas to affect the lens and cause irritation to the eye.
enlarged tonsils and/or adenoids
can present a significant obstacle to the adequate administration of N2O-O2. a deviated nasal septum can also potentially decrease the ease of gas flow through the entirety of the airway.
