Introduction to pain and anxiety control Flashcards
How to combat pain and anxiety (5)
Behavioural techniques - routine practice Combination of -LA -sedation: oral/ IHS/ IVS/ rectal -general anaesthesia Dependant upon pt/ tx factors Awareness of other professionals skilled in management Importance of team approach
Difficulty of dental treatment (5)
Co-operation Anxiety/ phobia Medical conditions/ mental health issues Involuntary movements More complex treatments/ quadrant dentistry
MDAS Phobia = (1)
19 or above
Basic behavioural management trategies (5)
Tell, show, do
Positive distraction e.g. music, ipod, TV
Relaxation
Systematic desensitisation - gradual acclimatisation
Hypnosis
Alternative management strategies (3)
Acupuncture Drugs -oral/ IHS/ IV sedation But consider -premedication -diazepam is in DPF/ ask GMP
Advanced behavioural management (3)
Pt selection Professional skills Assessment - refer to a team who specialise in dental phobia Management may include psychologists Ask GMP/ local psychology team/ SCD team
Describe sedation (3)
Depress CNS to allow operative treatment with minimum physiological and psychological stress
Modify patients state of mind and allow communication and patients response to commands
Have good safety margin so that consciousness is maintained and airway protected
Properties of ideal sedation agents (6)
Simple to administer Rapid onset Predictable action/ duration Rapid recovery Rapid metabolism/ excretion Low incidence of side effects
Sedation - oral premedication at home (4)
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
Sedation - oral in the surgery with monitoring (1)
10-20mg Temezepam
Inhalation sedation - ‘gas and air’ (6)
-Specialist equipment/training and surgery requirements (scavenging) - Patent nasal airway - Good for children - Minimal intervention - Analgesic - Hazards of chronic exposure
Intravenous sedation properties (9)
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 (6)
Good for epilepsy Movement disorders Stress related medical conditions Has a reversal agent - flumazanil Requires escort Requires cannulation and associated risks
IV sedation side effects - drug related (6)
Over sedation Cardiovascular depression Respiratory depression Specific drug interactions ?Tolerance Sexual fantasy
Second appropriate person (4)
At All Times
A second person trained in sedation is required
for sedation to be undertaken, this may be a
DN/ dentist/ anaesthetist
Monitoring
Chaperone
Team work (6)
All sedation methods require highly trained and
efficiently functioning dental teams
Regular training in and out of house
Multidisciplinary care of patients
Updated knowledge –courses and literature
Seek advice/second opinions
Refer if necessary
Costs (4)
Materials
Staff
Work time lost to patient/escort
Other consequences
Medicolegal aspects (3)
Same as any other treatments, additionally
Written consent
Escort requirements and
Appropriate post operative care
Regulation (3)
GA only undertaken in hospitals Standards for sedation following Poswillo report (1990) Sedation only undertaken in Registered and inspected premises With appropriately trained staff Appropriate equipment and drugs
GA stats (5)
2.9 million per year in the UK
death and persistent brain damage 1 per 180,000 GA’s
Obesity is a major risk of airway complications
Pre-op assessment important
Sedation to be undertaken in preference to GA
wherever possible -Conscious decision DoH 2000