Inhalation Sedation Flashcards
What are the contraindications for Inhalation Sedation?
Common cold- cannot breathe through their nose
Tonsillar/adenoid enlargement
Severe COPD
First trimester of pregnancy
Fear of the ‘mask’/claustrophobia
Patients with limited ability to understand
What are the indications for Inhalation Sedation?
Anxiety
Needle phobia
Gagging
Traumatic procedures
Medical conditions aggravated by stress
Unaccompanied adults requiring sedation
What equipment is included in inhalation sedation?
Gas cylinders
Pressure reducing valves
Flow control meter
Reservoir bag
Gas delivery hoses
Nasal hood
Waste gas scavenging system
What % oxygen can you not go below when delivering nitrous oxide?
30%
As there is 21% oxygen in the atmosphere so patient is always getting more oxygen than necessary
What is the air entrainment valve for?
If gases fail valve opens and allows air into circuit
What is the reservoir bag?
Emulates their lungs and checks breathing is correct (12-16 breaths per minute)
2 or 3 litre bag to help monitor respiration
Must not collapse and should move visibly with each inspiration and expiration
What are the gas delivery hoses?
Single use breathing circuits
One hose delivers fresh gas from machine
One hose delivers waste gas to scavenging system
-non return valve in expiratory limb prevents rebreathing expired gases
What is the scavenging system?
Active scavenging of waste gases: small negative pressure
Changing surgery air reduces nitrous oxide levels
Watch for patient mouth breathing. Check seal to reduce contamination
What is the oxygen flush button?
Flushes oxygen at 35 litres/min
For emergency use only
What are the advantages of inhalation sedation?
Rapid onset (2-3 mins)
Rapid peak action (3-5 mins)
Depth altered either way
Flexible duration
Rapid recovering
No injection for the sedation
Drug not metabolised
No amnesia
What are the disadvantages of inhalation sedation?
Equipment expensive
Gases expensive
Space occupying equipment
Requires ability to breathe through nose
Chronic exposure risk
Staff addiction
Difficult to accurately determine actual dose
What are the signs of adequate inhalation sedation? Name 4.
Patient relaxed/comfortable
Patient awake and able to interact
Reduced blink rate
Laryngeal reflexes unaffected
Vital signs unaffected
Gag reflex reduced
Mouth open on request
Decreased reaction to painful stimuli
Decrease in spontaneous movements
Verbal contact maintained
What are the symptoms of adequate inhalation sedation? Name 4.
Mental and physical relaxation
Lessened awareness of pain
Paraesthesia (tingling)- lips, fingers, toes etc
Lethargy
Euphoria
Detachment- ‘floating’ feeling
Warmth
Altered awareness of passage of time
Dreaming
Small controllable ‘fit of the giggles’
What are the signs and symptoms of over-sedation? Name 6
Mouth closing- repeatedly
Spontaneous mouth breathing
Nausea/vomiting
Irrational and sluggish breathing
Decreased co-operation
Incoherent speech
Uncontrollable laughter, tears
Patient no longer enjoying the effects
Loss of consciousness
How do you titrate the oxygen levels in inhalation sedation?
Set mixture dial to 100% oxygen and 5-6L per minute
Ensure patient is comfortable with the nasal hood securely attached
Reduce oxygen by 10%
Wait 1 minute and then repeat
When oxygen reaches 80%, then reduce by 5% per minute
Stop titration when patient is suitably sedated
