Complications of Conscious Sedation in Dentistry Flashcards
what are the common complications of cannulation?
- venospasm
- extravascular injection
- intraarterial injection
- haematoma
- fainting
what is Venospasm?
- disappearing vein syndrome
- veins collapse at attempted venepuncture
- accompanied by burning
- associated with poorly visible veins
what is extravascular injection?
Active drug placed into interstitial space
- causes pain & swelling
- problems with delayed absorption
how are extravascular injections prevented?
- good cannulation
- test dose of saline
How is a patient treated after accidental extravascular injection?
- remove cannula
- apply pressure
- reassure
How is an intra-arterial injection diagnosed?
- 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
How is accidental intra-arterial injection prevented?
- avoid anatomically prone sites
- palpate before injection
How is intra-arterial injection managed?
- monitor for loss of pulse
- leave cannula in situ for 5 mins
- no problems just remove
- symptomatic leave & refer to hospital
What is a haematoma?
Extravasation of blood into soft tissues due to damage to vein walls
- at venepuncture = poor technique
- removal of cannula = failure to apply pressure
How are haematomas prevented?
- good cannulation technique
- pressure post operatively
- care with elderly
How are haematomas treated?
- time
- rest
- reassurance
(if severe… initial ice pack & then moist heat 20 mins in hour after)
What complications are associated with IV sedation drug administration?
- hyper-responders
- hypo-responders
- paradoxical reactions
- oversedation
- allergic reactions
What are hyper-responders in relation to IV sedation?
Deep sedation with minimal dose (1-2mg midazolam)
What are hypo-responders in relation to IV sedation?
Little sedative effect with large doses
- usually due to tolerance
What are paradoxical reactions in relation to IV sedation?
Appear to sedate normally but react extremely to all stimuli (relax when stimuli removed)
What do you do if paradoxical reactions occur when giving IV sedation?
- check for failure of LA
- DO NOT GO ON ADDING SEDATIVE
- find other management technique
- watch immature teens
How do you know if oversedation has occurred?
- loss of responsiveness
- respiratory depression
- loss of ability to maintain airway
- respiratory arrest
How is oversedation managed?
- Stop procedure
- Try to rouse patient
- ABC
- If no response stimulation & response (reverse with flumazenil 200g then 100g increments at minute intervals)
How is respiratory sedation managed?
- check the oximeter
- stimulate patient (ask to breathe)
- supplemental oxygen (nasal cannulae 2 litres per minute)
- reverse with flumazenil
What allergic reactions are associated with IV sedation?
- latex
- elastoplast
** rare to be allergic to sedative itself
what complications are associated with inhalation sedation?
- oversedation
- patient panics
What are the signs & symptoms associated with nitrous oxide overdose?
- patient discomfort
- lack of cooperation
- mouthbreathing
- giggling
- nausea
- vomiting
- loss of consciousness
If someone is allergic to midazolam, and you have administered it… why should you not try to reverse it with Flumazenil?
Flumazenil is ALSO a benzodiazipine !!! potentially allergic to this too
How is an inhalation sedation overdose treated?
- decrease nitrous oxide concentration by 5-10%
- reassure
- don’t remove nosepiece (diffusion hypoxia)
