Inhalational Sedation Flashcards
What are the indications for inhalational sedation?
anxiety
needle phobic
Gaging
Traumatic experience
Medical conditions that are aggravated by stress
Unaccompanied adults that require sedation
What are the contraindications to inhaltional sedation?
Cold Tonsillar/adenoid enlargement severe COPD First trimester preganancy Claustrophobic Patients with a limited ability to understand
What equipment is needed for inhalational sedation?
Gas cylinders Pressure reeducing valve Flow control meter Resevoir bag Gas delivery hoses Nasal Hood Waste gas scavenger system
What pressure are the oxygen cylinders kept at?
1900psi
What colour are the oxygen cylinders?
Black with a white collar
What pressire are the NO cylinders kept at?
750psi
What colour are the NO cylinders?
Blue
When does the pressire guage for oxygen begin to fall and how does this differ for NO?
For Oxygen the guage starts to fall as soon as oxygen is used. for NO the guage stays constant until only 1/8 of the contents is left since NO is a liquid and the liquid vapourises keeping the pressure constant
what is the purpose of the pressure reducing valve?
this reduces the pressure to 45psi so pt can breathe easily
When using the flow control meter where is the reading taken from in relation to the ball?
it is taken from the equator of the ball
How accurate is the ball and flow meter?
5% plus or minus
What colour is the NO flow meter?
Blue
What is used to attach the oxygen cylinder to the yolk of the machine?
Pin index system which is unique to oxygen
What is there between the oxygen cylinder and the sedation machine?
A bodock seal
T/F the NO cylinder also has a Bodock seal?
T
What does the oxygen flow meter read?
Measures flow of oxygen up to 10l per min
What does the nitrous oxygen flow meter read?
Flow rate of up to 10l per min
What is the purpose of the air entrainment valve?
If gases fail then this valve enables room air to go into circuit
What is the purpose of the oxygen flush button?
This flushes 35l oxygen per minute and used in emergencies
What is the resevoir bag made from?
Silicone
How many litres can the resevoir bag hold?
2-3
What is the purpose of the oxygen resevoir bag?
It enables you to monitor respiration as it moves with respiration and it mustn’t collapse
What is the structure of the delivery hoses?
Corrugated 2.5cm diameter with universal joins
What is the purpose of having two hoses?
One hose delivers fresh gas
The other house takes away waste gas
What feature is incorporated in the expired gas hose?
A non return valve
T/F the scavenging system has a negative pressure?
True
A slight negative pressure
How does the scavenger system work?
It changes the surgery air 14 times per hour
How can you reduce contamination from NO?
Check mask correct size and check if patient is mouth breathing
What are the safety features incorporated into inhalational equipment?
Pin index system: prevents wrong cylinder from being attached Diameter index: hoses can only be attached on to oxygen or NO nt both Min Oxygen: 30% Oxygen fail safe: operates when oxygen is less then 40psi Air entrainment valve Oxygen flush button Colour coding Scavenger Pressure dials Pressure reducing valves One way exploratory valve Quick for hose connection
What are the disadvantage of inhalational sedation?
Expensive Need nasal breaking Gas expensive Space occupying Difficult to accurately determine dose Staff addiction Chronic exposure
What are the signs of adequate sedation?
Pt relaxed Pt awake Reduced blinking rate Laryngeal reflexes not affected Gag reflux obtunded Mouth open on request Decreased reaction to pain Decreased spontaneous movement Verbal contact maintained
What are the symptoms of adequate sedation?
Mental and physical relaxation Lessened awareness to pain Parasthesia of extremities Euphoria Lethargy Floating feeling Warmth Dreaming Altered awareness of time
What are the signs and symptoms of over sedation?
Mouth closing repeatedly Spontaneous mouth breathing Nausea Vom Sluggish responses Deceased co operation Incoherent speech LOC Pt not enjoying effects
What are the pre op instructions?
Have a light meal Take any routine meds Children must be accompanied by adults No alcohol Sensible clothing
What should the mixture dial be set to befor the treatment starts?
100% oxygen.
What should the flow be set to befor the treatment starts?
5-6l/min
How much should you reduce O2 by?
10% first and then after 80% reduce by 5%
How should you perform the recovery after treatment?
Increase O2 gradually by 10-20% then administer 100% O2 for two mins
What is the success rate for RA?
50-90%
Better in ortho xla
Worse in pain
T/F adults undergoing RA can leave unaccompanied?
T
T/F children can leave unaccompanied after RA?
F
Under 16 need a competant adult
What does RA succes depend on?
Appropriate selection and assessment
