dental sedation Flashcards
What are the 8 ideal qualities of a sedative?
1- predictable 2-inexpensive 3-painless on administering 4-immediate onset 5- entirely pleasant to the patient and provides anxiety relief 6- no side effects 7- rapid recovery on demand 8- no after effects
What are the 3 indications to use dental sedation?
1- to treat anxious/phobic patients. Or those with a movement disorder.
2-to enable an unpleasant treatment to be carried out without distress to the patient
3-to avoid general anaesthesia
What are the 3 types of fear?
- innate: built in from birth
- developed: from personal experience or from observing others
- phobia: fear out of proportion to the situation, can’t be reasoned away, leads to avoidance
What are the 7 things dental clinicians can do to help manage fear?
1- understand and assess the dental fear. Reassurance can be given and trust can be built.
2-explanation and information: communicate well with the patient to help them understand more about the treatment. Talk the patient through the procedure so that there are no surprises and warn the patient about sudden noises and strange sensations during the treatment.
3-Tell-show-do: take time to tell the patient about the procedure, the likely discomfort, the duration and show them what will be used.
4- relaxation: anxiety is related to physical tension. encourage the patient to breathe deeply.
5- distraction: focus on imagery, decor, music, toys
6- provide control: use stop signals
7-Systematic desensitisation. This means gradually introducing the patient to the feared situation, doing simple treatment in a staged way.
What are the 7 treatment methods used in dental sedation?
1- T.L.C. and other non-pharmacological techniques such as Cognitive Behavioural Therapy and hypnosis
2- Nitrous oxide inhalation sedation
3- Oral benzodiazepine premedication
4- Oral benzodiazepine sedation
5- Intravenous sedation
6- Transmucosal intranasal benzodiazepine sedation to allow cannulation
7- General anaesthesia
What are the advantages of nitrous oxide sedation?
- extremely safe and non invasive
- minimal impairment of cough and swallow reflexes
- rapid recovery with negligible hangover effects
- produces sedation and limited LA is needed
- suitable for all age groups
- few medical contraindications
What are the disadvantages of nitrous oxide sedation?
- need to breathe through nose with mouth wide open
- high concentration can cause headache/vomiting
- level of sedation is dependent on psychological support
- relies on communication and reasoning with patient
how is nitrous oxide administered?
-it is inhaled as a mixture of nitrous oxide (N2O) and oxygen (O2)
-the oxygen administered with the nitrous oxide is greater
than 20% (machine delivers minimum 30%).
-it is impossible for the machine to deliver 100% nitrous oxide
What is the pharmacology of nitrous oxide sedation? what does it look like? how is it metabolised? excreted? safety margin?
- N2O is colourless and odourless
- it is not metabolised
- excreted unchanged through the lungs
- it has a wide safety margin
What are the effects a patient may experience under nitrous oxide sedation?
- tingling feeling in fingers, toes, lips or tongue
- fear reduced
- pleasant euphoria, mild intoxication
- sense of detachment, floating or lethargic feeling
- physiology and reflexes normal
- responses may be sluggish
What are the 5 contraindications of nitrous oxide sedation?
1- pregnancy: avoid in 1st trimester
2-COPD: chronic obstructive pulmonary disorder
3-eye surgery: avoid if retinal surgery in the past 3 months
4- vitamin B12 deficiency
5- blocked nose (common cold)
What are Benzodiazepines?
where does it act on?
where is it broken down?
- drug that reduces anxiety and produces sedation
- it acts on GABA receptors
- broken down in the liver
How do Benzodiazepines affect the following categories?
- Anxiety?
- state of mind?
- movement?
- emotions?
- fat within the body?
- CVS effects?
- Respiration?
- Muscles?
- Age?
- Anxiolytic: detachment, anterograde amnesia
- Hypnotic: smaller doses will produce sedation without unconsciousness. An overdose will produce coma
- Anticonvulsant: Used in the treatment of epilepsy
- Disinhibition: Nervous patients may cry
- Lipophilic: Readily taken up by the brain, the liver and other fatty tissue
- CVS effects: Reduction in blood pressure and a very slight increase in heart rate
- Respiration: Respiratory depressants so care should be taken to administer slowly and monitor the patient
- Muscle: Relax muscles, influencing breathing and ability to walk
- Age: sensitivity to the drug increases with age, a much smaller dose is needed in older patients
What drug can be used to reverse the effects on benzodiazepine?
- Flumazenil.
- displaces the benzodiazepine from the GABA receptor. Having done so the neurone reverts back to its original state of excitability
what are the 3 methods of administering Benzodiazepines?
- oral (premedication and at the time of the appointment)
- intravenous
- transmucosal
