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BDS4 Sedation Symposium > IV sedation assessment > Flashcards

IV sedation assessment Flashcards

1
Q

What is the GDC definition of conscious sedation?

A

“A technique in which the 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 communication can be maintained and the modification of the patient’s state of mind is such that the patient will respond to command throughout the period of sedation. Techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.”

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2
Q

What is the main differences between sedation and GA?

A

Patient can respond to commands and can still communicate

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3
Q

Why is it essential that sedation assessment is carried out on a different day from treatment?

A

Allows patient to think about options (cooling off period)

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4
Q

What are the aspects involved in assessment for sedation?

A

History- Social, Dental, Medical

Examination-General, Oral, Vital signs

Treatment Plan

Consent

Information for patient and escort

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5
Q

What can be used to determine the nature of a patient’s anxiety who need sedative treatment?

A

MDAS

Also ask question about whether anxiety is general or specific.

Find out whether it is phobia or anxiety.

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6
Q

What aspects of a patients social history are important to consider in sedation?

A

Occupation- determine whether patient can return to work the following day (heavy treatment)

Need for escort- this is mandatory, they must stay in building and take them home

Alcohol- don’t want patient drinking at time of sedation

Transport- public (not recommended), private etc

Responsibilites- children

Age- may not be suitable for extremes of age

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7
Q

What aspects of dental history should be determined in sedation assessment?

A

Referral source eg Own GDP

Previous bad experience

Previous sedation / GA- Any problems?

Symptoms- Acute/Chronic

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8
Q

When may sedation be considered in a patient who is not anxious?

A

If procedure is difficult to tolerate- extraction of 3rd molars

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9
Q

How long should the procedure be in IV sedation?

A

The drug lasts for 45 mins and topping up is not advised. Therefore treatment must be completed in this time.

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10
Q

What can be used to check a patient’s medical history?

A

PMH sheets- go over this with patient and ask for more information about positive responses

Check meds on Trakcare

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11
Q

What can be used to check drugs that you are not sure about?

A

BNF

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12
Q

What should be checked in a drug history for the patient?

A

Allergies

Previous Anaesthetic/sedation- any issues?

Recreational drug use

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13
Q

Which drugs increase sedative effects of midazolam?

A

Alcohol

Opiods

Erythromycin

Antidepressants

Antihistamines

Antipsychotics

Recreational drugs

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14
Q

ASA Classification:

A

ASA I: Normal healthy patient-non-smoker, minimal alcohol

ASA II: Mild systemic disease

ASA III: Severe systemic disease; limits activity (but not incapacitating)

ASA IV: Severe systemic disease (constant threat to life)

ASA V: Moribund; not expected to live > 24 hrs.

ASA VI: Patient who is brain dead for organ donation

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15
Q

What are examples of ASA II patients?

A

Current smoker

Pregnancy

Well-controlled epilepsy

Well-controlled asthma

NID Diabetes Mellitus

BP = 140-159/90-94

Obesity (30-<40)

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16
Q

What are examples of ASA III patients?

A

ID Diabetes Mellitus

> 6/12 post MI

> 6/12 post stroke

stable angina

COPD

BP = 160-199/95-114

BMI>40

17
Q

What are examples of ASA IV patients?

A

unstable angina

< 3/12 post. MI or stenting

< 3/12 post. stroke

severe COPD

BP > 200/115

18
Q

Where should each ASA class be treated?

A

ASA I/II- May be treated in primary care

ASA III- should be treated in secondary care

ASA IV- must be secondary care

19
Q

Who should treat ASA III+ patients with sedation?

A

Anaesthetist lead services in hospital

20
Q

What is the issue with patients with respiratory disease and sedation?

A

Almost all sedatives cause respiratory depression (most patients can normally compensate)

21
Q

What should be ascertained about asthmatic patients before they receive sedation?

A

What drugs do they take- how often

Have they been hospitalised

Can it be exacerbated by stress

22
Q

What is the issue with patients with psychiatric disease and sedation?

A

Difficult group to treat in general

Benzos and antidepressants have synergistic effect in causing respiratory depression

23
Q

What is a pharmacodynamic interaction? Give examples:

A

Interactions between drugs which have similar or antagonistic pharmacological effects or S/E’s (predictable)

Antidepressants/Antihypertensives and benzos

24
Q

What is a pharmacokinetic interaction?

A

One drug alters the absorption, distribution, metabolism or excretion of another, thereby increasing or reducing the amount of drug available to produce its pharmacological effects (unpredictable but unusual)

25
Q

Why is sedation generally avoided in pregnant patients?

A

Theoretical risks of teratogenicity (not proven)

Risk of sedative effect on baby and drug being released via lactation

26
Q

What can be examined generally when evaluating anxiety?

A

Eye contact

Speech

Interaction with surroundings

Clinical signs

Vital signs

27
Q

What aspects of dentistry may make a patient anxious?

A

Mirror

Gloves

Radiographs

Surgery

Chair-being laid back (loss of control)

Surgeon

28
Q

Which vital signs are monitored in sedation?

A

HR

BP

Oxygen saturation

29
Q

How is BMI calculated?

A

Weight in kg over height in metres squared

30
Q

BMI classification:

A

Less than 18.5 = Underweight

Between 18.5 - 24.9 = Healthy Weight

Between 25 - 29.9 = Overweight

Over 30 = Obese

31
Q

What is the cut off BMI for sedation?

A

35
-> issues with resuscitation if chair breaks

32
Q

What is the cut off weight for dental chair?

A

28 stone

33
Q

What side effect of sedation is it important to remind the patient of?

A

Amnesia

34
Q

How can a patient worried about lack of control be reassured?

A

Remind them that they can stop at any moment and will have ability to do so

35
Q

What can be done to help a patient feel more comfortable about their treatment with sedation?

A

Written pre/post op instructions

Introduction to staff and surgery

Opportunity to ask questions

Thorough consent process

Appointment being soon after assessment (avoid overthinking)

BDS4 Sedation Symposium (8 decks)

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