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5th yr- AMS > Inhalation sedation 1 > Flashcards

Inhalation sedation 1 Flashcards

1
Q

Why do we need sedation

A

Dental anxiety

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2
Q

What is dental anxiety associated with

A
  1. Poor oral health
  2. Poor attendance
  3. Poor compliance with prevention
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3
Q

can GA be carried out in practice

A

no it used to be however now it must be carried out in an environment with critical care facilitates eg hospital

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4
Q

What does dental anxiety look like

A
  1. Irregular attenence
  2. Disruptive behaviour
  3. Low elf esteem
  4. Expecting the worst
  5. Increased heart and breathing rate
  6. Perspiration
  7. Dryness of mouth
  8. Muscle tension
  9. feeling dizzy, sick or butterflies in tummy
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5
Q

Define conscious sedation

A

A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out but during which verbal contact is maintained throughout

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6
Q

What must the drug and techniques used to carry out sedation ensure

A

Should carry a margin of safety wide enough to render loss of consciousness unlikely

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7
Q

What are the properties of an ideal sedative agent

A
  1. Wide margin of safer
  2. No adverse side effects
  3. Reversible
  4. Easy to administer and titrate
  5. Rapid onset and recovery
  6. Anxiolytic
  7. Analgesic
  8. Easily accepted by patient
  9. Inexpensive
  10. Minimum integration with other drugs or systems
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8
Q

Define Anxiolytic

A

Reduces anxiety

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9
Q

In the UK name the main inhalation sedation agent we use

A

Nitrous oxide

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10
Q

Who discovered nitrous oxide

A

Joseph Priestley In 1772

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11
Q

Who first reported the analgesic properties of nitrous oxide

A

Humphrey Davey in 1799

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12
Q

When was nitrous oxide first used clinically

A

in 1844 by Horace wells

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13
Q

Describe nitrous oxide

A

Colourless gas at room temperature that is reported to have a slightly sweet odour
it is 1.5x the density of room air

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14
Q

How is nitrous oxide stored

A

Stored as liquid in blue cylinders at 750 psi

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15
Q

List some of the properties of nitrous oxide

A
  1. Non flammable
  2. Non irritant to mucosa
  3. Relatively insoluble in blood
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16
Q

What are the clinical effects of nitrous oxide

A
  1. Rapid onset of effects
  2. Depression of the CNS
  3. Relaxation
  4. Paraesthesia
  5. Sedation
  6. Analgesia
  7. Euphoria
  8. Mild depression of the respiratory system
  9. Mild effects on the cardiovascular system
17
Q

What can high doses of nitrous oxide cause

A

Nausea and heachahes

18
Q

Talk through the action of nitrous oxide

A
  1. Inhaled through nose
  2. Raises partial pressure of nitrous oxide in lungs
  3. Nitrous oxide is forces into bloodstream across alveolar membrane
  4. Nitrous oxide is carried to the brain
  5. Gas exchanges within the brain producing effect
19
Q

How is the analgesic effect of nitrous oxide achieved in the brain

A

Due to integration with opioid receptors in the mid brain

20
Q

How is the anxiolytic effect of nitrous oxide achieved in the brain

A

Due to interaction with GABA receptors

21
Q

What can happen rarely in inhalation sedation cases

A

Diffusion hypoxia

22
Q

What causes diffusion hypoxia

A

Rapid elimination of nitrous oxide from the blood

23
Q

What happens in diffusion hypoxia

A

Large volumes of nitrous oxide enter the lungs
This can displace oxygen from the alveoli causing diffusion hypoxia

24
Q

How can diffusion hypoxia be avoided

A

By giving 100% oxygen for more than 3mins

25
Q

Name an acute adverse effect of nitrous oxide

A

Hypoxia leading to nausea or dizziness

26
Q

Who can be affected by chronic adverse effects of nitrous oxide

A
  1. Staff from repeated exposure
  2. Substance abuse
27
Q

What causes chronic adverse effects of nitrous oxide

A

Oxidation of vitamin B12 which reduces methionine synthetase

28
Q

What effects can chronic effects of nitrous oxide have

A
  1. Haematological eg pernicious anaemia
  2. Neurological
  3. Malignancy
  4. Reproductive eg spontaneoud abortion
  5. Liver and kidney
29
Q

How do we limit adverse effects on staff

A
  1. Exposure limit of 100ppm for time weighted average 8 hour period
  2. Active scavenging 45l per min
  3. Good technique using minimal effective dose
  4. Risk assessment for pregnant staff
30
Q

What is scavenging in terms of nitrous oxide inhalation

A

Actively removing excess nitrous oxide

31
Q

What are the indication of inhalation sedation

A
  1. Mild to moderate dental anxiety
  2. Traumatic procedures
  3. Gag reflex
  4. Medically compromised patients
  5. Prior to IV sedation for cannulation
32
Q

What are the contra indications for inhalation sedation

A
  1. Upper respiratory tract infections
  2. Chronic respiratory disease
  3. Pregnancy
  4. Blocked nose
  5. Pre co operative children
  6. Ocular surgery
  7. If PT is taking methotrexate and bleomycin
33
Q

Which two medications are a contraindication fr inhalation sedation

A

methotrexate and bleomycin

34
Q

What are the advantages of inhalation sedation with nitrous oxide

A
  1. Simple non invasive
  2. Rapid onset and recovery
  3. Can regulate depth of sedation
  4. Minimal effect on cardio respiratory system
  5. Minimal interaction with other drugs
  6. Easily reversed with 100% oxygen
35
Q

What are the advantages of inhalation sedation with nitrous oxide

A
  1. Nasal mask is not always accepted
  2. Nasal hood can interfere with treatment especially central incisors
  3. Some degree of patient compliance is required
  4. Need continuous nitrous oxide delivery
  5. Cost of equipment
  6. Nitrous oxide pollution

5th yr- AMS (11 decks)

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