Complications of Conscious Sedation in Dentistry

Question 1

what are the common complications of cannulation?

Answer 1

• venospasm
• extravascular injection
• intraarterial injection
• haematoma
• fainting

Question 2

what is Venospasm?

Answer 2

• disappearing vein syndrome
• veins collapse at attempted venepuncture
• accompanied by burning
• associated with poorly visible veins

Question 3

what is extravascular injection?

Answer 3

Active drug placed into interstitial space
- causes pain & swelling
- problems with delayed absorption

Question 4

how are extravascular injections prevented?

Answer 4

• good cannulation
• test dose of saline

Question 5

How is a patient treated after accidental extravascular injection?

Answer 5

• remove cannula
• apply pressure
• reassure

Question 6

How is an intra-arterial injection diagnosed?

Answer 6

• pain on venepuncture
• red blood in cannula
• difficult to prevent leak
• pain radiating distally from site of cannulation
• loss of colour or warmth to limb/weakening pulse

Question 7

How is accidental intra-arterial injection prevented?

Answer 7

• avoid anatomically prone sites
• palpate before injection

Question 8

How is intra-arterial injection managed?

Answer 8

• monitor for loss of pulse
• leave cannula in situ for 5 mins
• no problems just remove
• symptomatic leave & refer to hospital

Question 9

What is a haematoma?

Answer 9

Extravasation of blood into soft tissues due to damage to vein walls
- at venepuncture = poor technique
- removal of cannula = failure to apply pressure

Question 10

How are haematomas prevented?

Answer 10

• good cannulation technique
• pressure post operatively
• care with elderly

Question 11

How are haematomas treated?

Answer 11

• time
• rest
• reassurance
  (if severe… initial ice pack & then moist heat 20 mins in hour after)

Question 12

What complications are associated with IV sedation drug administration?

Answer 12

• hyper-responders
• hypo-responders
• paradoxical reactions
• oversedation
• allergic reactions

Question 13

What are hyper-responders in relation to IV sedation?

Answer 13

Deep sedation with minimal dose (1-2mg midazolam)

Question 14

What are hypo-responders in relation to IV sedation?

Answer 14

Little sedative effect with large doses
- usually due to tolerance

Question 15

What are paradoxical reactions in relation to IV sedation?

Answer 15

Appear to sedate normally but react extremely to all stimuli (relax when stimuli removed)

Question 16

What do you do if paradoxical reactions occur when giving IV sedation?

Answer 16

• check for failure of LA
• DO NOT GO ON ADDING SEDATIVE
• find other management technique
• watch immature teens

Question 17

How do you know if oversedation has occurred?

Answer 17

• loss of responsiveness
• respiratory depression
• loss of ability to maintain airway
• respiratory arrest

Question 18

How is oversedation managed?

Answer 18

1. Stop procedure
2. Try to rouse patient
3. ABC
4. If no response stimulation & response (reverse with flumazenil 200g then 100g increments at minute intervals)

Question 19

How is respiratory sedation managed?

Answer 19

• check the oximeter
• stimulate patient (ask to breathe)
• supplemental oxygen (nasal cannulae 2 litres per minute)
• reverse with flumazenil

Question 20

What allergic reactions are associated with IV sedation?

Answer 20

• latex
• elastoplast

** rare to be allergic to sedative itself

Question 21

what complications are associated with inhalation sedation?

Answer 21

• oversedation
• patient panics

Question 22

What are the signs & symptoms associated with nitrous oxide overdose?

Answer 22

• patient discomfort
• lack of cooperation
• mouthbreathing
• giggling
• nausea
• vomiting
• loss of consciousness

Question 23

If someone is allergic to midazolam, and you have administered it… why should you not try to reverse it with Flumazenil?

Answer 23

Flumazenil is ALSO a benzodiazipine !!! potentially allergic to this too

Question 24

How is an inhalation sedation overdose treated?

Answer 24

• decrease nitrous oxide concentration by 5-10%
• reassure
• don’t remove nosepiece (diffusion hypoxia)