Conscious Sedation and GA in Dentistry Flashcards
What is the definition of conscious sedation
a technique in which the use of a drug OR drugs produces a state of depression of the CNS enabling treatment to be carried out, but during which VERBAL contact with the patient is maintained throughout the period of sedation.
what TYPES OF CONSCIOUS SEDATION do we have?
- inhalation
- INTRAVENOUS
- oral
What does Inhalation Sedation involve? (5)
- the use of NITROUS OXIDE and OXYGEN
- delivered as a GAS via nose piece mask
- we will get ‘mild’ sedation
- success in (some) children and adults
- THEY MUST HAVE THE ABILITY TO BREATHE THROUGH THERE NOSE
What are some common features of nitrous oxide? (5)
- an INHALED gas
- sweet smelling
-colourless - heavy
- sometimes referred to as ‘laughing gas’
what are some PROPERTIES of nitrous oxide (6)
- rapid onset of action (3-5mins)
- crosses the blood brain barrier rapidly
- elimination also rapid
- no significant metabolism by kidneys or liver
- not stored in the tissues
- NO hangover effect!
What are the SIDE EFFECTS of nitrous oxide?
- headache
- nausea
- vomiting
- DIFFUSION HYPOXIA
What is diffusion hypoxia? (3)
- when nitrous oxide is discontinued, it leaves the blood more quickly than nitrogen from the air is absorbed into the body
- can lead to DILUTION OF OXYGEN IN THE LUNGS which can lead to HYPOXIA
- ADMINISTER 100% OXYGEN AFTER CESSATION OF NITROUS OXIDE FOR 5 MINS TO PREVENT THIS
What are some indications for Inhalation sedation? (why might we consider this for a patient) - (4)
- mild anxiety
- needle phobia?
- patient not suitable for IV/GA
- Straightforward/mild dental treatment
What are some considerations we may need to take into account for providing IHS? (5)
- is the patient ABLE to cooperate? this may be dependant on there:
- age
- learning disability/cognitive impairment
- ability to TOLERATE mask
- MASK MAY IMPEDE ACCESS TO ANTERIOR TEETH - procedure dependant
What are the CONTRA-INDICATIONS of IHS (why may we not use ihs) - 7
- patients with COPD - due to increased risk of pneumonia, probably due to increased risk of aspiration (fluid entering persons airway and into lungs by accident)
- recent eye or ear surgery
- mask intolerance
- pregnancy - due to early fetal development/preterm labour
- vitamin B12 deficiency - neurological and haematological toxic effects can occur as it can inactivate B12
- methotrexate interaction?
- chemo interaction
What is IV sedation? (8)
- delivered as an injection
- most commonly used is MIDAZOLAM
- for patients with mild-moderate anxiety
- NEED TO CANULATE
- there is a need for escort post treatment ?
- required to follow rules?
- AMNESIA - can sometimes have memory loss?
- must ALSO HAVE A REVERSAL DRUG - flumazenil
What are the indications for IV sedation? (4)
for
- dental anxiety/phobia
- medically suitable
- social history???
- an unpleasant procedure being carried out- we may want to relax the patient more if this puts them more at ease , it is good for taking the nip out of LA injections (anxyliotic/analgesic effect)
What are the contraindications for iv sedation (5)
pts who
- needle phobia
- medical reasons eg obesity so higher dosage risk and therefore increased sedation risks, elderly
- social reasons
- pregnancy
- poor venous access - as we inject in this type of sedation
What does oral sedation involve? - (4)
- delivered as a DRINK - usually midazolam
- less common technique than IV or IHS
- NOT the same as pre-med!!!
- we must still canulate for safety reasons
What is the definition of a PRE-MED (2)
- PRELIMINARY administration of a drug preceding diagnostic, therapeutic, or surgical procedure as an antibiotic or antianxiety agent
- a drug administered for SUCH A PURPOSE
