Intro to pain and anxiety Flashcards

1
Q

How to manage pain and anxiety?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How to control pain and anxiety?

A
Important to facilitate tx and ongoing management
Failure of this = dental phobia 
Pt concerns/tx requirements
PHM/FH/SH
Professional training and support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What makes dental tx difficult?

A
Co-operation
Anxiety/phobia
Med conditions/mental health issues
Involuntary movements
More complex tx/quadrant dentistry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What to do if you do not have the skills to manage an anxious pt?

A

Know someone who does and refer pt for specialist advice/management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Basic behavioural management strategies?

A
Tell, show, do
Positive distraction - music, TV
Relaxation
Systematic desensitisation
Hypnosis 

Pt selection
Professional skills
Team/environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Alternative management strategies for anxiety?

A

Acupuncture
Drugs - oral, IHS/IV sedation
Consider premedication, diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Advanced behavioural management?

A

Refer to a team who specialise in dental phobia
Management may include psychologists
Ask GMP/local psychology team/ SCD team

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is sedation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What makes an ideal sedative agent?

A
Simple to administer
Rapid onset
Predictable action/duration
Rapid recovery
Rapid metabolism/excretion
Low incidence of side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Oral sedation types?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Positives of oral sedation?

A

Simple to administer
Predictable action/duration
Low incidence of side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Inhalation sedation features?

A
Specialist equipment/training and surgery requirements
Patent nasal airway
Good for children
Minimal intervention
Analgesic
Hazards of chronic exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Positives of inhalation sedation?

A
 Simple to administer
 Rapid onset
 Predictable action/duration
 Rapid recovery
 Rapid metabolism/excretion
 Low incidence of side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Intravenous sedation?

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

IV sedation - who is it good for?

A

Good for epilepsy, movement disorders, stress related medical conditions
As has a reversal agent - flumazanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

IV sedation features?

A

Has a reversal agent - flumazanil
Requires escort
Requires cannulation and associated risks

17
Q

IV sedation side effects?

A
Drug related:
Over sedation
CV depression
Resp depression
Specific drug interactions
?Tolerance
Sexual fantasy
18
Q

IV sedation positives?

A
Simple to administer
 Rapid onset
 Predictable action/duration
 Rapid recovery
 Rapid metabolism/excretion
 Low incidence of side effects
19
Q

What is needed for sedation?

A

A second trained person in sedation at all times
May be a DN/dentist/anaesthetist
Monitoring
Chaperone

20
Q

Why is teamwork essential for sedation?

A
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
21
Q

Costs of sedation?

A
Materials
Staff
Work time lost to patient/escort 
Other consequences
LA vs GA vs sedation
22
Q

Medicolegal aspects for sedation?

A

Written consent

Escort requirements and appropriate post op care

23
Q

Where is GA only undertaken?

A

In hospitals

24
Q

Where is sedation undertaken?

A

In registered and inspected premises
With appropriately trained staff
Appropriate equipment and drugs

25
What standards for followed for sedation?
Poswillo report 1990
26
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