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Paediatrics > Inhalation Sedation > Flashcards

Inhalation Sedation Flashcards

1
Q

Read articles

A

Read articles

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2
Q

What is conscious sedation

A
  • Technique that produces a state of central nervous system depression to enable treatment to be delivered
  • But during which verbal contact with the patient is maintained throughout the period of sedation
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3
Q

Use SDCE guidelines

A

Use

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4
Q

What can the patient do during conscious sedation

A
  • They are conscious
  • Independently retains protective reflexes and a stable patent airway
  • Understands and repsonds to verbal stimuli throughout
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5
Q

Examples of conscious sedation

A
  • Inhalation sedation
  • oral
  • Transmucosal (nasal)
  • Intravenous
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6
Q

Aims of conscious sedation for the child

A
  • Prevent and reduce dental fear, anxiety and procedure associated pain
  • Facilitate cooperation
  • Promote a positive attitude and response to treatment
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7
Q

Aims of conscious sedation for the dentist

A
  • Facilitate safe provision and completion of quality care by minimising disruptive behaviour
  • Leave child fit for safe discharge at end of treatment
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8
Q

Options for managing dental anxiety

A
  • Behaviour management
  • Behaviour therapy
  • Conscious sedation
  • GA
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9
Q

Indications of IHS

A
  • Manageent of mild anxiety
  • Gag reflex
  • Medically compromised patients
  • Traumatic procedures
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10
Q

Contraindications of IHS

A
  • Upper respiratory tract issues
  • Blocked nose
  • Medical contras
  • Pre cooperative children
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11
Q

What gas(s) is used in IHS

A
  • Nitrous oxide

- With oxygen

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12
Q

Pharmocology of nitrous oxide

A
  • Colourless and virtually odourless gas
  • Insoluble
  • rapidly excreted by the lungs
  • Much more soluble than nitrogen in blood (diffusion hypoxia therefore may occur)
  • Euphoria and CNS depressant effect. Decreases memory, concentration and intelligence
  • Minimal effect on respiratory system
  • Non-irritant to mucosa
  • Minor decrease in cardiac output
  • Slight increase in peripheral resistance thereby maintaining blood pressure
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13
Q

What kind of med comp pts is ihs good at treating and why

A
  • Cerebrovascular system disorders
  • Minor decrease in cardiac output
  • Slight increase in peripheral resitance so maintains BP
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14
Q

3 main modes of actions of NOS

A
  • Analgesic effect: works on opioid receptors
  • Anxiolytic effect: resembles that of benzodiazepines, initiated at GABA receptors
  • Anaesthetic effect: GABA receptors
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15
Q

Aims of N2o

A
  • Reduce or eliminate anxiety
  • Reduce untoward movement and reaction to dental tx
  • Enhance communication and pt cooperation
  • Raise pain reaction threshold
  • Increase tolerance for longer appointments
  • reduce gag
  • Aid in tx of medical compromised its
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16
Q

Safety checks for ihs

A
  • Plug oxygen and nitrous tubing
  • Make sure all fitting nicelyy and not loose
  • Turn moisture to 100% ox and flow meter to 6l/min
  • Check that nitrous oxide is 0
  • Change mixture to 50 and see how it changes
  • Stop common gas outlet with balm of hand and press oxygen flush. Bag should inflate. No leaks
  • If you pull out oxygen check both go to 0
17
Q

Medical Contras to IHS

A
  • Nasal obstruction/congestion
  • Severe forms of respiratory disease (COAD, emphysema)
  • Middle ear disease/infections
  • Neuromuscular disorders (MS, 3myasthenia gravis)
  • Porphyria (enzyme disorder)
  • anti-folate meds eg. methotrexate
  • bleomycin chemotherapy
18
Q

Pre-op checks

A 
Consent form signed 
Med history 
Nasal congestion
Chaperone should be present throughout 
Nasal hood allow a good seal
19
Q

Sensations of ihs

A

Floating
Tingling of fingers and toes
Heaviness or lightness

20
Q

Technique in terms of increments

A
  • Incremental increase of nitrous oxide in 5-10% increments
  • Monitor patients breathing
  • Calm monotone voice
  • Encourage nasal breathing
  • Use rubber dam to protect airway
  • 100% oxygen for 3-5 mins to prevent diffusion hypoxia at the end of treatment
21
Q

Signs and symptoms of ideal sedation

A

Signs:

  • Slightly increased BP and HR initially
  • Normal and smooth respirations
  • Peripheral vasodilation
  • Flushing of extremities and face
  • Decreased muscle tone as anxiety decreases
  • Arms and legs relax

Symptoms

  • Light headedness
  • Tinging of hands and feet
  • Wave of warmth
  • Feeling of vibration throughout the body
  • Numbness of the hands and feet
  • Numbness of oral soft tissues
  • Euphoric feeling
  • Analgesia
  • Lightness of extremities
22
Q

What should u monitor during tx

A
  • Responsiveness
  • Colour
  • Respiratory rate
  • Rhythm
23
Q

what is the main post complication of nitrous oxide

A
  • Diffusion hypoxia
  • During the recovery period
  • rapid release of nitrous oxide from blood stream into alveoli thereby diluting concentration of oxygen
  • Reduces alveolar oxygen tension, which then produces hypoxia
  • May lead to headache, disorientation, nause and can be avoided by administering 100% oxygen spot treatment
24
Q

What should be documented in the notes

A
  • Name of assistant
  • Name of escort
  • Time of administration
  • Tidal flow
  • Proportion of N20/O2 reached
  • Amount of o2 given /
  • State of patient during
  • State of patient after
  • Time of departure
25
Q

Reasons for failure and management

A

Mouth breathing instead of nose breathing

  • Encourage nose breathing
  • Ensure not blocked

No effective seal around nosepiece
-Adjust so effectively fitting

Too anxious and not able to cooperate
-Stop and consider other options

Fault in machine
-Stop and check equipment

Resisting the effect

  • USe BM techniques
  • Consider other options
26
Q

Advantages of IHS

A
  • Non invasive and well tolerated
  • Easily titratable and adjust level of sedation
  • Wide margin of safety if used by suitably trained operator
  • Rapidly absorbed (2-3 mins onset)
  • Rapidle eliminated (5 mins complete recovery)
  • Minimal impairment of reflex
  • Reduced anxiety to follow ups
  • Some analgesic effect
  • Cost effective alternative to GA
  • Reduces awareness of pain
27
Q

Disadvantages of IHS

A
  • Lack of potency
  • Relies on psychological reassurance
  • Nasal mask may impede access
  • Effective nasal breathing requires
  • Nitrous oxide pollution
  • Variable post op amnesia
  • LA still required
28
Q

Potential adverse effects of IHS

A
  • HEadahces, nausea and vomiting up to 10%
  • Loss of consciousness
  • Unfavourable psychological reactions
29
Q

Chronic exposure effects (usually occupational)

A

Haematological effects
-Impaired RBC production and pernicious anaemia

Reproductive effects

  • Avoid in pregnancy
  • Offer pregnant staff choice
  • Exposure to N20 should not exceed 100ppm for an 8 hour period
30
Q

How can nitrous oxide pollution be reduced

A
  • Active scavenging systems
  • Good ventilation
  • Floor level extractor fans
  • Good technique with the patient
  • Equipment that has been checked and serviced on a regular basis

Paediatrics (16 decks)

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