Inhalation sedation Flashcards
What are the indications
Anxiety
Needle phobia
Gagging
Traumatic procedures
Medical conditions aggravated by stress
Unaccompanied adults requiring sedation
What are the contraindications
Common cold
Tonsillar/adenoidal enlargement
Severe COPD
First trimester of pregnancy
Fear of “mask” /Claustrophobia
Patients with limited ability to understand
Doesnt work for severe dental anxiety
What equipment is needed
Gas cylinders
Pressure reducing valves
Flow control meter
Reservoir bag
Gas delivery hoses
Nasal hood
Waste gas scavenging system
How much O2 is used wit hO2 emergency flush button
35l/min
What safety features are there
Pin index system – prevents the wrong cylinder being attached
Diameter index system – prevents cross connection of piping
Minimum oxygen delivery 30%
Oxygen fail safe – operates when oxygen pressure < 40 psi
Air entrainment valve
Oxygen flush button
Oxygen monitor
Reservoir bag
Colour coding
Scavenging system
What are the Adv
Rapid onset (2-3 mins)
Rapid peak action (3-5 mins)
Depth altered either way
Flexible duration
Rapid recovery
No injection (for the sedation but obviously LA still required depending on the procedure)
Few side effects to patient
Drug not metabolised
Some analgesia (though better for iscaemic than inflammatory pain)
No amnesia
What are the DisAdv
Equipment expensive
Gases expensive
Space occupying equipment
Not potent
Requires ability to breath through nose
Chronic exposure risk
Staff addiction
Difficult to accurately determine actual dose
What are the signs of an adequate sedation
Patient relaxed/comfortable
Patient awake
Reduced blink rate
Laryngeal reflexes unaffected
Vital signs unaffected
Gag reflex obtunded
Mouth open on request
Decreased reaction to painful stimuli
Decrease in spontaneous movements
Verbal contact maintained
What are the symptoms of an adequate sedation
Mental and physical relaxation
Lessened awareness of pain
Paraesthesia – lips, fingers, toes, legs, tongue
Lethargy
Euphoria
Detachment ‘floating feeling’
Warmth
Altered awareness of passage of time
Dreaming
Small controllable “fit of the giggles”
Wha are the S&S of an over sedation
Mouth closing – repeatedly
Spontaneous mouth breathing
Nausea/vomiting
Irrational and sluggish responses
Decreased cooperation
Incoherent speech
Uncontrolled laughter, tears
Patient no longer enjoying the effects
What are the pre-op instructions
Have a light meal before appointment
Take routine medicines as usual
Children accompanied by a competent adult
Adults accompanied at their first sedation appt. afterwards may then attend alone
Do not drink alcohol on day of appointment
Wear sensible clothing
Arrange care of children during and after your appointment
Plan to remain in clinic for up to 30 minutes after treatment
What is the technique
Set up the machine
Select nasal hood (record size in notes)
Connect to hoses
Set mixture dial to 100% O2
Settle patient in dental chair
Reinforce explanations of procedure
Set flow to 5-6l per minute
Position hood on the patient’s nose
Encourage nasal breathing
Patient to be comfortable with hood before proceeding – about 1 minute
Ask patient to signal when begin to feel different
Reduce O2 by 10%
Wait 1 minute and repeat
After O2 reaches 80%, reduce by 5% per minute
Stop titration when patient ready for treatment
If patient over-sedated what do you do
increase O2 in 5-10% increments until satisfactory sedation
If patient under-sedated what do you do
decrease O2 in 5% increments until satisfactory sedation
What do you do at the recovery stage
Gradually increase O2 by 10-20% per minute until 100% or can turn straight to 100%
Administer 100% O2 for 2-3 minutes to prevent diffusion hypoxia
