Intro to pain and anxiety control Flashcards
Definition of conscious sedation
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which **verbal contact with the patient is maintained **throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to understand and respond to verbal commands. “Deep sedation” in which tese criteria are not fulfilled must be regarded as GA. In the case of patients who are unable to respond to verbal contact even when fully conscious the normal method of communicating with them must be maintained e.g. sign language
bold are key points
What are the medical indications for sedation
Conditions aggravated by the stress of dental treatment (need to be well controlled)
* Ischaemic heart disease
* hypertension
* asthma
* epilepsy
* psychosomatic illness (somatoform disorders)
* Misc conditions (UC or Crohn’s etc)
Conditions which affect cooperation
* mild to moderate movement or learning difficulties
* spasticity disorders
* parkinson’s disease
Psychosocial indications for sedation
- Phobias (things in mouth, dental procedures, needles if they don’t mind it in their arm, drills)
- gagging
- persistent fainting
- Idiosyncrasy to LA (feel faint after LA)
What is a phobia
An irrational and uncontrollable fear, which is related to a specific object or situation. It is persistend, despite avoidance of the provoking stimulus. It has a direct effect on the patient’s lifestyle.
Causes of dental anxiety?
- Trauma
* Primary traumatic experience
* usually in childhood
* may be cumulative - Transference (Learned)
* parenteral
* playground - Fear of Criticism
- Fear of dress (we look v. clinical)
- Lack of communication
- Helplessness (invading personal space)
- invasion of body orifice
- Influenced by environment
- surgery appearance
- staff continuity
- age
- stage of development
* young and old
* young adults
* learning difficulties - Gender (debatable)
- socio-economic group (>deprived = > anxiety)
Dental indications for sedation
Difficult or unpleasant procedures
* surgical extraction of wisdom teeth
* orthodontic extractions e.g. exposures of canines
* implants
Medical contraindications to sedation
- severe or uncontrolled systemic disease
- severe mental or physical disability (unable to communicate or understand)
- severe psychiatric problems
- narcolepsy
- hypothyroidism
- Myastesia Gravis (could affect breathing)
What ASA classifications is IV sedation only used in
ASA1 or ASA2
bonus qu
What are the ASA classifications
- A normal healthy patient
- A patient with mild systemic disease (well controlled)
- A patient with severe systemic disease (or poorly controlled)
- A patient with severe systemic disease that is a constant threat to life
- A moribund patient who is not expected to survive without the operation
- A declared brain-dead patient whose organs are being removed for donor purposes
Medical contraindications to IV Sedation
- intracranial pathology e.g. head trauma
- COPD
- Myasthenia gravis
- Hepatic insufficiency
- Pregnancy and lactation
COPD - could affect breathing
Hepatic insufficiency - unable to metabolise drug
Pregnancy/latcation - sedate baby
Medical contraindications to inhalaitonal sedation
- blocked nasal airway
- COPD
- Pregnancy
blocked nasal airway - NiO needs to be inhaled
COPD - contraversial
Pregnancy - can be harmful for baby (pregnant dentists too)
Social contraindications to sedation
- unwilling
- uncooperative
- unaccompanied
- children - for IV (<12yrs)
- Very old
Dental contraindications to sedation
- Procedure too difficult for LA alone - if patient willing
- Procedure too long
- Spreading infection (airway threatening, limits LA)
- Procedure too traumatic
Advantages to sedation
IV and inhalational
- decrease dentist stress
- decrease staff stress
- decrease patient stress
- fewer medical incidents
- more productive appointments
Disadvantages to sedation
IV and inhalational
- Training required
- equipment required
- recovery time and after care
recovery time and after care more for IV
