complications Flashcards
what drug is used for intravenous sedation in dentistry and what group of drugs does it belong
midazolam
a benzodiazepine
venospasm
dissapearing vein syndrome
veins collapse at attemped venepuncture - a protective mechanism by the body
associated with poorly visible veins
extravascular injection
active drug placed into interstitial space
sees pain and swelling in the area and results in delayed absorption
how can extravascular injection be avoided
good cannulation and a test dose of saline through the cannula prior to the drug
intra arterial injection diagnosis
pain on venepuncture, red blood in cannula, pressure may see blood pouring from cannula, pain radiating distally from canula site, loss of colour/ warmth to limb, weakening pulse
If canulating in antecubital fossa ragion where should you always go to avoid an intra arterial injection
always go lateral to bicep tendon to avoid brachial artery and median nerve
extravasation
unintentional leakage of liquid from a vein into surrounding tissues
haematoma
extravasation of blood into soft tissues
management of an intra-arterial injection
monitor for loss of pulse
leave canula in place for 5 mins post drug, if no problems remove, if symptoms leave in place and refer to the hospital
why may a haematoma be seen after cannulation
damage to vein walls
either due to poor technique during venepuncture or not applying pressure upon removal of cannula
hyper responders (to sedation)
experience deep sedation with minimal dose , drug should be given very slowly and in small amounts
deep sedation with even just 1-2mg midazolam)
average dose midazolam for dental sedation
5-6mg
hyporesponders to sedation
little sedative effect even with large dose
(check cannula definetly in vein!)
what type of patients may be hyporesponders to sedation
recreational drug users
recommended dose at which to abandon attempted IV sedation if patient not responding
7.fivemg midazolam
paradoxical reaction to sedation
appear to sedate normally but then react extremely to all stimuli
rare occurence, do not continue adding sedative
respiratory arrest
absence of breathing
what is the reversal agent for a benzodiazepine overdose
flumazenil
what must be continuously monitored if a patient is over sedated (IV) and why
oxygen saturation levels must constantly be monitored
midazolam causes respiratory depression, potential for loss of airway and respiratory arrest
what should not be given if a patient presents with an allergy to the sedative midazolam
reversal agent
flumazenil is also a BZD so will likely also be allergic to this
elimination half life
length of time it takes for concentration of drug to decrease to half of its starting dose in the body
dictates working time
distribution half life
time for plasma concentration to decline by 50% during distribution phase
what half life dictates working time
elimination half life
elimination and distribution half life of midazolam
elimination - 1 to 2 hours
distribution - 15 mins
what drug is used for inhalation sedation
nitrous oxide
signs and symptoms of oversedation (inhalation)
lack of cooperation , giggling, nausea, vomiting, mouth breathing, loss of consciousness
if an inhalation sedation patient shows signs of oversedation why should the nose piece not immediately be removed and what should be done instead
should not be removed immediately as this risks diffusion hypoxia
N2O concentration should be slowly decreased in 5-10% increments
