Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oral Surgery 2 > IV Sedation > Flashcards

IV Sedation Flashcards

1
Q

Dentistry is mostly in what stages of sedation?

A

Minimal to moderate

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

Minimal IV sedation is used for ___

Moderate sedation is used for ____

A

Anxiolysis

Conscious sedation

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

The minimal number of available personnel for sedation should be ___. what are their roles?

A

3

Operator (performs procedure) (must be ACLS certified)

Assistant (aids the operator) (must be BLS certified)

Monitor (watches vitals, and should recognize associated complications)

*one of the individuals must be capable of establishing a patient airway and positive pressure ventilation

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

What is the most common thing people die of during sedation?

A

Not breathing

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

True or false.. depending on the patient, they can go from minimal to general sedation pretty quickly

A

True

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

Describe the effects that minimal sedation (anxiolysis) has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.

A

Responsiveness: normal response to verbal stimulation

Airway: unaffected

Spontaneous ventilation: unaffected

Cardiovascular function: unaffected

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

Describe the effects that moderate sedation (conscious sedation) has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.

A

Responsiveness: purposeful response to verbal or tactile stimulation

Airway: no intervention required

Spontaneous ventilation: adequate

Cardiovascular function: usually maintained

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

Describe the effects that deep sedation has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.

A

Responsiveness: purposeful response following repeated or painful stimuli

Airway: intervention may be required

Spontaneous ventilation: may be inadequate

Cardiovascular function: usually maintained

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

Describe the effects that general anesthesia has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.

A

Responsiveness: Unarousable even with painful stimuli

Airway: intervention often required

Spontaneous ventilation: frequently inadequate

Cardiovascular function: may be impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Minimal sedation (anxiolysis) is a drug-induced state during which patients respond _______. Although cognitive function and physical coordination may be impaired, ___, ____ , and ____ functions are unaffected.

A

Normally to verbal commands

Airway reflexes, ventilatory, and cardiovascular functions

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

Moderate sedation (conscious sedation) is a drug-induced depression of consciousness during which patients respond ____ to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a ___, and _____ is adequate. ____ function is usually maintained.

A

Purposefully

Airway

Spontaneous ventilation

Cardiovascular

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

Deep sedation is a drug-induced depression of consciousness during which pts cannot be easily aroused but respond _____. The ability to independent maintain ____ may be impaired. Pts may require assistance in maintaining a ____ and sponteous ____ may be inadequate. Cardiovascular function is usually maintained.

A

Purposefully following repeated or painful stimulation

Ventilatory function

Patent airway

Ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

General anesthesia is a drug-induced loss of consciousness during which pts are not ____, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Pts often require assistance in ___ and positive pressure ventilation may be required because of depressed ____ or drug induced depression of neuromuscular function. ____ function may be impaired.

A

Arousable

Maintaining patent airway

Spontaneous ventilation

Cardiovascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Practitioners intending to produce a given level of sedation should be able to rescue pts whose level of sedation becomes deeper than intended. Individuals administering moderate sedation should be able to rescue pts who enter a state of ___. Those administering deep sedation should be able to rescue pts who enter a state of ___

A

Deep sedation

General anesthesia

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

What precautions should you take with pts who have cardiopulmonary disease?

A

Cardiopulmonary disease may accentuate hemodynamic/respiratory depression caused by sedatives and analgesics. May require decreased drug dosages; EKG monitoring warranted.

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

Hepatic or renal abnormalities may impair ____, causing altered ____ and ____ when sedatives/analgesics are administer.

A

Drug metabolism

Sensitivity and duration of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alcohol/illicit substance abuse may ___ tolerance to sedatives/analgesics while acute use prior to conscious sedation will be ____ with medication effects.

A

Increase

Additive or synergistic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does tobacco use affect sedation?

A

Increases airway irritability and risk for bronchospasm during sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The patient undergoing conscious sedation should have a thorough airway assessment focusing on what four things?

A

Airway class

Mouth opening

Thyromental distance (distance form chin to thyroid)

Rand of motion of the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the mallampati classification?

A

Evaluation of the exposed uvula and soft palate when pt is sitting upright, mouth open, and tongue maximally procured WITHOUT speaking or saying “ahh”

21
Q

Describe mallampati class 1

A

Soft palate, uvula, pillars visible

This individual should be easy to mask, ventilate, or incubate with a laryngoscope and endotracheal tube

22
Q

Describe the mallampati class 2

A

Soft palate and uvula are visible (no pillars)

This individual should be easy to mask, ventilate, or incubate with a laryngoscopes and endotracheal tube

23
Q

Describe the mallampati class 3

A

Soft palate, base of uvula visible

This indivial may be hard to mask, ventilate and incubate

24
Q

Describe the mallampati class 4

A

Soft palate not visible at all

This classification is very difficult to intubate

25
Q

True or false…

Used alone, the mallampati tests have limited accuracy for predicting the difficult airway and thus are not useful screening tests. The mallampati classification is only one of 11 non-reassuring findings during airway examination

A

True

26
Q

What are some nonreassuring findings during airway PE?

A

Long upper incisors

Prominent overbite

Pt cannot bring mandibular incisor anterior to maxillary incisors

Interincisor distance less than 3cm

Mallampati class 3 or 4

Palate highly arched or very narrow

Thyromental distance less than 3 finger breadths

Short neck length

Thick neck circumference

Pt cannot touch tip of chin to chest or cannot extend neck

27
Q

What is the thyromental distance?

A

Measures the distance between chin and thyroid cartilage (should be at least 3 finger breadths)

28
Q

True or false. You really should only sedate ASA 1 or 2

A

True

29
Q

What is the minimum fasting period for…

Clear liquids

Breast milk

Nonhuman milk

Light meal

Fatty/meaty meal

A

Clear liquids = 2h

Breast milk = 4 h

Nonhuman milk = 6h

Light meal = 6h

Fatty/meaty meal = 8 or more hours

30
Q

How does a pulse oximeter work?

A

Transcutaneous measurement of the ratio of venous to are their land blood. Done by % absorption of light waves length of 660 and 940nm

O2 saturation is calculated by a mathematical algorithm

Assumes absence of methemoglobin and carboxyhemoglobin

Delayed information (1-2 minutes)

31
Q

A pulse oximetry has a false reading in what circumstances?

A

Low body-core temp

Vasoconstriction

Hypotension

Deep skin pigmentation

Methemoglobinemia

Carboxyhemoglobinemia

Nail polish*

32
Q

The mathematical algorithm used in a sphygmomanometer ___ high blood pressure and ___ low blood pressure

A

Underestimates

Overestimates

When in doubt, use a manual sphygmomanometer

33
Q

Capnography is a measurement by ____.

A

Infrared spectroscopy

Waveform tracks “absorption peak CO2” at 4200nm wavelength

Real time graphic assessment gives visual demonstration of ventilatory status

Can be “end tidal” or transcutaneous

34
Q

What are the limitations of capnography?

A

In non-closed system (not intubated), using a modified nasal cannula or nasal hood, measurement may be inaccurate due to missing of expired air and dead space.

This is mandatory for deep or general anesthesia

35
Q

Normal ETCO2 in the adult patient should be ____mmHg

A

35-45

Hypoventilation > 45mmHg

Hyperventilation < 35 mmHG

This is a direct measurement of ventilation in the lungs

It indirectly measures metabolism and circulation

36
Q

Opioids provide analgesia and sedation. It ___ cough reflexes. It is ___ lipid soluble. It is metabolized in the ___.

A

Depresses

Highly lipid soluble (rapidly distributed to tissues and produce long-lasting effects by accumulation in fat reservoirs)

Liver. (Some active metabolites are excreted via the kidneys)

37
Q

What are four adverse effects of opioids?

A

Decreased respiratory drive

Potential increases in PCO2

Alterations in hemodynamics and bradycardia

GI upset and itching (constipation)

38
Q

Elderly and pediatric pts are often more sensitive to the effects of opioids. Why?

A

Elderly have decreased hepatic and renal function

Pediatrics have immature BBB and renal function

39
Q

A standard way of evaluating opioid potency is to compare equianalgesic doses of a drug with morphine. Compare morphine to meperidine, hydromorphone, and fentanyl.

A

Morphine is 10x more potent than meperidine

Morphine is 10x less potent than hydromorphone

Morphine is 100x less potent than fentanyl

40
Q

Benzodiazepines enhance ___ transmission in CNS. Most are ___ soluble (except __). What are its effects?

A

GABA

Lipid (except midazolam)

Effects: amnesia, anticonvulsant, anxiolytic, behavior disinhibition

41
Q

Benzodiazepines may cause dose-related ____ depression, ___ and ____, particularly in the elderly. Midazolam administered rapidly is likely to produce ___.

A

Respiratory depresssion

Hypotension

Tachycardia

Apnea

42
Q

True or false… benzodiazepines are generally contraindicated in pregnancy. Diazepam and lorazepam may cause thrombophlebitis

A

True

43
Q

What is the elimination half life of diazepam?

A

20-70 hours

44
Q

True or false… propofol has analgesic properties

A

False. It has sedation and amnesia effects

45
Q

True or false… ketamine is an NMDA antagonist. It causes dissociated anesthesia. It is a potent pain reliever

A

True

46
Q

____ is an opioid antagonist which binds to CNS opioid receptors to displace opioid agonists. It reverses respiratory depression and sedation associated with opioids. It may be displaced from CNS receptors by additional doses of opioid. Its half life is shorter than opioids

A

Naloxone

47
Q

What is the reversal agent used for benzodiazepines?

A

Flumazenil

Reverses sedation, respiratory depression and paradoxical agitation, and causes cessation of amnesia following its administration

48
Q

What are the reversal agents for propofol and ketamine?

A

They have NO reversal agents

Oral Surgery 2 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions