Complications of Conscious Sedation in Dentistry Flashcards
1
Q
Historically what factors contributed to complications of conscious sedation in dentistry?
A
- bolus sedation used
- untrained seditionists
- incorrect doses given
- mixed up labels
- incorrect concentration
- reliance on flumazenil
2
Q
What are the possible complications of cannulation?
A
- venospasm
- extravascular injection
- intraarterial injection
- haematoma
- fainting
3
Q
What is venospasm?
A
- disappearing vein syndrome
- increased with poor technique
- must ensure good dilation
- quick insertion
- increased with poor technique
- vein collapse at attempted venipuncture
- on insertion of cannula
- may be accompanied by burning
- associated with poorly visible veins
4
Q
How is venospasm managed?
A
- dilating vein
- should be well dilated
- worse with repeated attempts
- efficient technique
- slow puncture makes worse
- warm water/gloves
- better vasodilation
5
Q
What is extravascular injection?
A
- active drug placed into interstitial space
- cannula not inserted into vein
- symptoms
- pain
- swelling
- liquid bubbles up in tissue
- delayed absorption
- delayed sedation
- 20-30 minutes
- drug still absorbed so treatment must be delayed
- delayed sedation
6
Q
How is extravascular injection managed?
A
- prevention
- good cannulation
- test dose of saline
- ensures in vein
- treatment
- remove cannula
- apply pressure
- reassure
- midazolam is non-irritant
7
Q
What is intra-arterial injection?
A
- cannulation of artery
- often brachial artery if antecubital fossa
- must cannulate lateral to bicep tendon
- high blood pressure can push cannula out
- often brachial artery if antecubital fossa
- symptoms
- pain on venepuncture
- thicker artery wall
- radiates distal to cannulation site
- red blood in cannula
- difficult to prevent leaks
- loss of colour or warmth to limb
- visible or weakened pulse
- pain on venepuncture
8
Q
How are intra-arterial injections managed?
A
- prevention
-insert lateral to bicep tendon
- if antecubital fossa cannulation- palpate before insertion
- management
- monitor for loss of pulse
- cold
- discolouration
- leave cannula in situ for 5 minutes post drug
- if no problems, remove
- if symptomatic leave
- refer to hospital
- administer procaine 1%
- monitor for loss of pulse
9
Q
What is a haematoma and how does it occur because of cannulation?
A
- extravasation of blood into soft tissues
- damage to vein walls
- can occur at venipuncture
- poor technique
- puncture both side of vein
- blood pooling
- can occur at removal of cannula
- failure to apply pressure
- particularly common in elderly patients
10
Q
How can haematoma be prevented?
A
- good cannulation technique
- avoid multiple holes in vein wall
- pressure post-operatively
- operator should apply, not patient
- 2-3 minutes afterwards
- take care with elderly
11
Q
How can haematoma be treated?
A
- time
- rest
- reassurance
- in severe cases
- initially apply ice pack
- moist heat for 20 minutes
- after 24 hours
- consider heparin gel
12
Q
Why can fainting occur during venepuncture?
A
- anxiety related to venepuncture
- low blood sugar
- anxious patients may not eat
- increased chance of fainting
- accompanied by shaking or tremoring
- urinary incontinence is possible
- bowel incontinence is not a faint
13
Q
How can fainting during venepuncture be managed?
A
- prevention
- encourage patients to eat
- topical anaesthesia
- management
- lie patient down
- raise legs
14
Q
What are the possible complications of drug administration during intravenous sedation?
A
- hyper-response
- hypo-response
- paradoxical reactions
- over sedation
- allergic reactions
15
Q
What is considered a hyper-response to intravenous sedation and how is it managed?
A
- deep sedation with minimal dose
- 1-2mg midazolam
- care with titration
- reason for 1mg increments
- even slower with elderly
- very sensitive
