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

Inhalation Sedation II Flashcards

1
Q

What is the spectrum of pt management?

A 
TLC
LA
Suggestion/ hypnosis
IHS
Oral sedation 
IV sedation
GA
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2
Q

Advantages IHS?

A 
Non-invasive
Rapid onset and recovery
Minimal impairment of reflex
No fasting required
Adult pt don't need escort
Some analgesic effect
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3
Q

Disadvantages IHS?

A 
Lack of potency of nitrous oxide
Expensive equipment
Requires clear nasal airway
Intrusion make into operating field 
Chronic staff exposure 
Lack operator control
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4
Q

What patients are suitable?

A 
Unpleasant tx
Anxious pt
Needle phobics
Those gag easily - reflex dulled
Medically compromised - unsuitable IV
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5
Q

What are general contraindications?

A 
Nasal obstruction - can't breath in nitrous oxide
Severe pulmonary conditions
Cyanosis due cardaic/ respiratory diseae
Inability to communicate/ co-operate
Pregnancy 
Masks interrupt operative work
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6
Q

What drug contraindicates use of IHS?

A

Methotrexate

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7
Q

Why is methotrexate a contraindication to providing IHS

A

Nitrous oxide increase risk of methotrexate toxicity - drug interaction

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8
Q

When is methotrexate used?

A

Autoimmune conditions e.g rheumatoid, psoriasis, neoplastic disease

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9
Q

What medical conditions contraindicate IHS?

A

Muscle wasting - myasthenia gravis
Claustrophobia
Recent ophthalmic surgery using gas
Any air entrapment in body e.g head injury/ pneumothorax

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10
Q

Why is muscle waisting contraindication IHS?

A

Drug relax muscle to point respiratory depression

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11
Q

Why are those w/ psychiatric disorders contraindicated to have IHS?

A

Struggle understand expectations

Hard breath through nose calm and consistently

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12
Q

Ideal properties sedating agent

A 
Alleviate anxiety
Degree amnesia and analgesia
Maintain protective reflex
Prolong operating time
Rapdily effective
Easily eliminated
No side effects
Easily administered
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13
Q

What is oxygen?

A

Clear, colourless and odourless gas

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14
Q

What state is oxygen in when in the cylinder?

A

Gaseous

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15
Q

What colour is oxygen cylinder?

A

Black w/ white shoulder

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16
Q

What is nitrous oxide?

A

Sweet smelling, colourless gas

17
Q

What colour is nitrous oxide cylinder

A

Blue

18
Q

What state is nitrous oxide in in cylinder?

A

Liquid when under pressure

19
Q

How know amount of nitrous oxide in cylinder?

A

Weigh

20
Q

MAC nitrous oxide?

A

105% - weak anaesthetic

21
Q

What are systematic effects nitrous oxide?

A

Depression CNS

Slight depression CVS at high []

22
Q

Effects chronic exposure to nitrous oxide?

A

Increased risk of miscarriage
Decreases fertility
Pernicious anemia due issue via B12 synthesis

23
Q

What is entonox?

A

50% oxygen and 50% nitrous oxide

24
Q

Why doe entonox need to be used at room temp?

A

Cause uneven distribution of gas within cylinder

25
Q

What are diff planes of nitrous oxide analgesia?

A

Plane 1 - moderate sedation
Plane 2 - dissociation sedation and analgesia
Plan 3 - total analgesia

26
Q

What % for plane 1?

A

5-25%

27
Q

What % for plane 2?

A

20-50%

28
Q

What % for plan 3?

A

50%+

29
Q

What is MAC?

A

Minimum alveolar concentration - measure anaesthetic potency

30
Q

What is MAC of nitrous oxide?

A

105%

31
Q

When is MAC reduced?

A

elderly

by other sedative - alcohol, antihistamines, benzodiazepine

32
Q

What is theory of diffusion hypoxia?

A

Rapid elimination of nitrous oxide into lungs dilutes oxygen within alveolus lowering alveolar oxygen concentration, reduces ventilatory drive causing hypoxia/ hyperventilation

33
Q

How to prevent diffusion hypoxia?

A

Routine administration 100% oxygen for 3-5 mins post -op

34
Q

How to reduce occupations exposure?

A

Improve ventilation
Active and passive scavenging
Regular machine chekcs

35
Q

Safety features of IHS?

A 
Pinned system
Colour coded cylinders and tubing 
Oxygen fail-cut out
30% minimum oxygen
Oxygen flush
Reservoir bag
Scavenging

5th ICP - Pain/ Anxiety (10 decks)

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