Complications of Conscious Sedation in Dentistry Flashcards
complications of IV sedation?
venospasm
extravascular infection
intraarterial injection
haematoma (bruising)
fainting
whats a venospasm?
disappearing vein
vein collapses at attempted injection site
usually happens with poorly visible veins
how do you manage venospasm?
make sure veins dilated (warm room)
slow efficient technique
the more attempts you do, the worse the venospasm will be - do it in 1 go ideally
whats an extravascular injection?
active drug placed into interstitial space, pt will be sore and swollen
results in delayed absorption
how do u manage extravascular injection?
prevention:
good cannulation
test dose of saline (saline flush)
Tx:
remove cannula
apply pressure
reassure pt they will be ok
whats an intra-arterial injection?
inject cannula into artery
pain on venepuncture
red blood in cannula
pain radiating distally from site of cannulation
how do you manage an intraarterial injection?
avoid anatomically probe sites:
antecubital fossa (medial to bicep tendon)
palpate area before injection
monitor pt for loss of pulse
leave cannula in situ for 5 mins
How does haematoma happen during IV sedation?
extravasation of blood into soft tissues
due to damage to vein walls
what are the complications of drug administration during IV sedation?
hyperresponders
hyporesponders
paradoxical reactions
oversedation
allergic reactions
whats the management protocol when a pt is oversedated?
STOP
Try to rouse patient
Check ABC (Airway, Breathing, Circulation)
If no response to stimulation & support - reverse with FLUMAZENIL 200micrograms, then 100microgram at 1min intervals
how do you manage respiratory depression?
check oximeter
stimulate pt (ask them to breathe)
supplement oxygen
REVERSE WITH FLUMAZENIL
whats signs & symptoms of N2O overdose (IS)?
pt discomfort
lack of cooperation
mouthbreathing
giggling
nausea
vomiting
loss consciousness
how do you treat overdose IS?
decrease N2O conc by 5-10%
Reassure
DONT remove nosepiece (diffusion hypoxia)
