IV Sedation Flashcards
Dentistry is mostly in what stages of sedation?
Minimal to moderate
Minimal IV sedation is used for ___
Moderate sedation is used for ____
Anxiolysis
Conscious sedation
The minimal number of available personnel for sedation should be ___. what are their roles?
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
What is the most common thing people die of during sedation?
Not breathing
True or false.. depending on the patient, they can go from minimal to general sedation pretty quickly
True
Describe the effects that minimal sedation (anxiolysis) has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.
Responsiveness: normal response to verbal stimulation
Airway: unaffected
Spontaneous ventilation: unaffected
Cardiovascular function: unaffected
Describe the effects that moderate sedation (conscious sedation) has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.
Responsiveness: purposeful response to verbal or tactile stimulation
Airway: no intervention required
Spontaneous ventilation: adequate
Cardiovascular function: usually maintained
Describe the effects that deep sedation has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.
Responsiveness: purposeful response following repeated or painful stimuli
Airway: intervention may be required
Spontaneous ventilation: may be inadequate
Cardiovascular function: usually maintained
Describe the effects that general anesthesia has on responsiveness, airway, spontaneous ventilation, and cardiovascular function.
Responsiveness: Unarousable even with painful stimuli
Airway: intervention often required
Spontaneous ventilation: frequently inadequate
Cardiovascular function: may be impaired
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.
Normally to verbal commands
Airway reflexes, ventilatory, and cardiovascular functions
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.
Purposefully
Airway
Spontaneous ventilation
Cardiovascular
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.
Purposefully following repeated or painful stimulation
Ventilatory function
Patent airway
Ventilation
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.
Arousable
Maintaining patent airway
Spontaneous ventilation
Cardiovascular
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 ___
Deep sedation
General anesthesia
What precautions should you take with pts who have cardiopulmonary disease?
Cardiopulmonary disease may accentuate hemodynamic/respiratory depression caused by sedatives and analgesics. May require decreased drug dosages; EKG monitoring warranted.
Hepatic or renal abnormalities may impair ____, causing altered ____ and ____ when sedatives/analgesics are administer.
Drug metabolism
Sensitivity and duration of action
Alcohol/illicit substance abuse may ___ tolerance to sedatives/analgesics while acute use prior to conscious sedation will be ____ with medication effects.
Increase
Additive or synergistic
How does tobacco use affect sedation?
Increases airway irritability and risk for bronchospasm during sedation
The patient undergoing conscious sedation should have a thorough airway assessment focusing on what four things?
Airway class
Mouth opening
Thyromental distance (distance form chin to thyroid)
Rand of motion of the neck
What is the mallampati classification?
Evaluation of the exposed uvula and soft palate when pt is sitting upright, mouth open, and tongue maximally procured WITHOUT speaking or saying “ahh”
Describe mallampati class 1
Soft palate, uvula, pillars visible
This individual should be easy to mask, ventilate, or incubate with a laryngoscope and endotracheal tube
Describe the mallampati class 2
Soft palate and uvula are visible (no pillars)
This individual should be easy to mask, ventilate, or incubate with a laryngoscopes and endotracheal tube
Describe the mallampati class 3
Soft palate, base of uvula visible
This indivial may be hard to mask, ventilate and incubate
Describe the mallampati class 4
Soft palate not visible at all
This classification is very difficult to intubate
