Intro to pain and anxiety Flashcards
How to manage pain and anxiety?
Behavioural techniques
LA
Sedation: oral/IHS/IVS/Rectal
GA
Dependant upon pt/tx factors
Awareness of other professionals skilled in management
Importance of a team approach
How to control pain and anxiety?
Important to facilitate tx and ongoing management Failure of this = dental phobia Pt concerns/tx requirements PHM/FH/SH Professional training and support
What makes dental tx difficult?
Co-operation Anxiety/phobia Med conditions/mental health issues Involuntary movements More complex tx/quadrant dentistry
What to do if you do not have the skills to manage an anxious pt?
Know someone who does and refer pt for specialist advice/management
Basic behavioural management strategies?
Tell, show, do Positive distraction - music, TV Relaxation Systematic desensitisation Hypnosis
Pt selection
Professional skills
Team/environment
Alternative management strategies for anxiety?
Acupuncture
Drugs - oral, IHS/IV sedation
Consider premedication, diazepam
Advanced behavioural management?
Refer to a team who specialise in dental phobia
Management may include psychologists
Ask GMP/local psychology team/ SCD team
What is sedation?
Depression of CNS to allow operative tx with the minimum physiological and psychological stress
Modify pt’s state of mind and allow communication and the pt’s response to commands
Have a good safety margin, so that consciousness if maintained and airway protected
What makes an ideal sedative agent?
Simple to administer Rapid onset Predictable action/duration Rapid recovery Rapid metabolism/excretion Low incidence of side effects
Oral sedation types?
Oral premedication at home
- Reduces anxiety in advance of tx and facilitates attendance
- Diazepam 2-5mg the morning of tx/attendance
- Temezepam 10mg the night before
- Ask GMP for advice/to prescribe
Oral in the surgery with monitoring
- 10/20mg Temezepam
Positives of oral sedation?
Simple to administer
Predictable action/duration
Low incidence of side effects
Inhalation sedation features?
Specialist equipment/training and surgery requirements Patent nasal airway Good for children Minimal intervention Analgesic Hazards of chronic exposure
Positives of inhalation sedation?
Simple to administer Rapid onset Predictable action/duration Rapid recovery Rapid metabolism/excretion Low incidence of side effects
Intravenous sedation?
With pulse oximeter monitoring Midazolam titrated according to response 20-30mins good sedation, improved co-operation Anxiolytic Anterograde amnesia Muscle relaxant Anticonvulsant Min cardiovascular/resp depression No analgesic effects
IV sedation - who is it good for?
Good for epilepsy, movement disorders, stress related medical conditions
As has a reversal agent - flumazanil
IV sedation features?
Has a reversal agent - flumazanil
Requires escort
Requires cannulation and associated risks
IV sedation side effects?
Drug related: Over sedation CV depression Resp depression Specific drug interactions ?Tolerance Sexual fantasy
IV sedation positives?
Simple to administer Rapid onset Predictable action/duration Rapid recovery Rapid metabolism/excretion Low incidence of side effects
What is needed for sedation?
A second trained person in sedation at all times
May be a DN/dentist/anaesthetist
Monitoring
Chaperone
Why is teamwork essential for sedation?
Requires highly trained dental teams Regular training in and out of house Multidisciplinary care of pts Updates knowledge Seek advice/2ndry opinions Refer if necessary
Costs of sedation?
Materials Staff Work time lost to patient/escort Other consequences LA vs GA vs sedation
Medicolegal aspects for sedation?
Written consent
Escort requirements and appropriate post op care
Where is GA only undertaken?
In hospitals
Where is sedation undertaken?
In registered and inspected premises
With appropriately trained staff
Appropriate equipment and drugs
What standards for followed for sedation?
Poswillo report 1990
Risk of death and persistent brain damage per GA?
1 per 180,000
Obesity - risk of airway complications
= Pre-op assessment important
Sedation preferred to GA where possible
