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5th ICP - Pain/ Anxiety > Inhalation Sedation 1 > Flashcards

Inhalation Sedation 1 Flashcards

1
Q

What is conscious sedation?

A

A technique using a drug/s to produce state of depression of the CNS enabling treatment to be carried out

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2
Q

If have conscious sedation what is maintained?

A

Protective reflex e.g swallow and verbal contact

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3
Q

Types of sedation techniques?

A 
Inhalation
IVS
Transmucosal
Oral
Intramuscular
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4
Q

What drug is given for inhalation sedation?

A

Nitrous oxide/ oxygen - combination

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5
Q

What drug is given for IV sedation?

A

Midazolam

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6
Q

What can be used for transmural sedation?

A

Midazolam

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7
Q

What drugs can be used orally for sedation?

A

Temazepam, diazepam, midazolam

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8
Q

When is oral sedation useful?

A

Premedication

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9
Q

What is used for IM sedation?

A

Ketamine

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10
Q

What are some properties of nitrous oxide?

A

Volatile
Denser than air
Least potent anaesthetic gas
Poorly soluble - rapid onset and recovery

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11
Q

What is MAC

A

Minimal alveolar concentrate

Minimum [] to provide surgical anaesthesia for 50% population

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12
Q

What is MAC nitrous oxide?

A

104

Means can’t be provided alone to prevent feeling surgery

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13
Q

How does nitrous oxide work?

A

Inhaled into lungs via nasal mask
Travel down pressure gradient from alveolus into blood
Hardly metabolised as exhaled quicker
Excreted through lungs

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14
Q

Propertiies of nitrous oxide?

A

Analgesic
Mild anaesthetic
Hypnotic
Anxiolytic

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15
Q

How is nitrous oxide an anxiolytic?

A

Acts on central nervous system through interaction GABA

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16
Q

What are 4 stages anaesthesia?

A
  1. Analgesia
  2. Excitement
  3. Surgical analgesia
  4. Respiratory paralysis
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17
Q

What % of nitrous oxide to reach moderate sedation?

A

5-25% nitrous oxide

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18
Q

What % nitrous oxide produces dissociation sedation and alangesia?

A

20-55%

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19
Q

What happens in dissociation analgesia?

A

Susceptibel to suggestion

20
Q

What % needs of nitrous oxide to provide total analgesia?

A

50-70%

21
Q

What risk of providing high levels nitrous oxide?

A

Loss consciousness

22
Q

What signs suggest adequate sedation?

A 
Awake and relaxed
In suggestive state
Giggling
Verbal response
Maintain open mouth 
Reduced blink rate
Spontaneous respiration
23
Q

What signs suggest over sedation?

A 
Hysterical laughter, tears
Decreased co-operation
Nausea
Mouth closing
Snoring 
Irrational response
LOC
24
Q

What are social indications of sedation?

A

Mild anxiety, needle phobia, gagging, fainting

25
Q

Why is IHS good for people who faint?

A

Continuous oxygen flow prevent faint

26
Q

Medical indications for sedation?

A

Conditions aggravated by stress
Continuous oxygen delivery beneficial - asthma
Conditions affecting co-operation

27
Q

Benefit IHS?

A

Avoid GA

28
Q

Social contraindications of IHS?

A

Severe anxiety
Claustrophobia
No consent or escort

29
Q

Medical contraindications iHS?

A 
Blocked nose
URTI 
Unable nose-breah
Recent eye/ middle ear/ sinus surgery
Pregnancy - even if only escorting child
myasthenia gravis
30
Q

What medical conditions are contraindication to IHS?

A

Myasthenia gravis

Bleomycin therapy

31
Q

What dental procedures are contraindicated to IHS?

A

Tx upper anterior teeth - lip become trapped

32
Q

Name safety features on IHS?

A 
Pin index - can't plug wrong gas canisters
Scavenging 
Nasal mask and tubing 
Oxygen failsafe
Max 70% nitrous oxide
Oxygen flush 
Reservoir
33
Q

Purpose of scavenging?

A

Important HCP don’t inhale gas, this is provided through nasal mask

34
Q

What is oxygen fail safe?

A

If cuts off nitrous oxide also cut so never give 100% nitrous oxide

35
Q

What is max amount nitrous oxide can be given via safety features?

A

70%

36
Q

When is oxygen flush used?

A

High rate oxygen delivered to bring pt out of sedation - not pleasant

37
Q

What does reservoir bag do?

A

Monitor pt breathing

38
Q

What are pre-op instructions for IHS?

A

Have light meal
Take routine medications
Child must be accompanied
Aware may cause dizziness/ nausea/ headache

39
Q

How long must oxygen be left after IHS?

A

3 mins to prevent diffusion hypoxia

40
Q

What happens if turned off w/o oxygen?

A

Nitrous oxide moves through pressure gradient quicker oxygen- lungs flooded with nitrous oxide and could become hypoxic (theoretical)

41
Q

What does COSHH recommend to reducing exposure?

A

Active scavenging - 45L/min
Passive scavenging - floor level
Supplementary high vol aspiration

42
Q

Other ways to reduce risk of exposure?

A

Rubber dam
Well-fitting mask
Good technique

43
Q

What are categories of occupational hazards?

A

Reproductive
Haematological
Neurological

44
Q

What are reproductive occupations hazards?

A

Risk miscarriage
Reduced fertility
Poss risk teratogenesis

45
Q

What are haematological risks?

A

Impair DNA synthesis
Oxidisation B12
Pernicious anaemia

46
Q

Neurological risks of iHS?

A

Peripheral neuropathy

5th ICP - Pain/ Anxiety (10 decks)

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