IV sedation assessment Flashcards
What is the GDC definition of conscious sedation?
“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.”
What is the main differences between sedation and GA?
Patient can respond to commands and can still communicate
Why is it essential that sedation assessment is carried out on a different day from treatment?
Allows patient to think about options (cooling off period)
What are the aspects involved in assessment for sedation?
History- Social, Dental, Medical
Examination-General, Oral, Vital signs
Treatment Plan
Consent
Information for patient and escort
What can be used to determine the nature of a patient’s anxiety who need sedative treatment?
MDAS
Also ask question about whether anxiety is general or specific.
Find out whether it is phobia or anxiety.
What aspects of a patients social history are important to consider in sedation?
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
What aspects of dental history should be determined in sedation assessment?
Referral source eg Own GDP
Previous bad experience
Previous sedation / GA- Any problems?
Symptoms- Acute/Chronic
When may sedation be considered in a patient who is not anxious?
If procedure is difficult to tolerate- extraction of 3rd molars
How long should the procedure be in IV sedation?
The drug lasts for 45 mins and topping up is not advised. Therefore treatment must be completed in this time.
What can be used to check a patient’s medical history?
PMH sheets- go over this with patient and ask for more information about positive responses
Check meds on Trakcare
What can be used to check drugs that you are not sure about?
BNF
What should be checked in a drug history for the patient?
Allergies
Previous Anaesthetic/sedation- any issues?
Recreational drug use
Which drugs increase sedative effects of midazolam?
Alcohol
Opiods
Erythromycin
Antidepressants
Antihistamines
Antipsychotics
Recreational drugs
ASA Classification:
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
What are examples of ASA II patients?
Current smoker
Pregnancy
Well-controlled epilepsy
Well-controlled asthma
NID Diabetes Mellitus
BP = 140-159/90-94
Obesity (30-<40)
What are examples of ASA III patients?
ID Diabetes Mellitus
> 6/12 post MI
> 6/12 post stroke
stable angina
COPD
BP = 160-199/95-114
BMI>40
What are examples of ASA IV patients?
unstable angina
< 3/12 post. MI or stenting
< 3/12 post. stroke
severe COPD
BP > 200/115
Where should each ASA class be treated?
ASA I/II- May be treated in primary care
ASA III- should be treated in secondary care
ASA IV- must be secondary care
Who should treat ASA III+ patients with sedation?
Anaesthetist lead services in hospital
What is the issue with patients with respiratory disease and sedation?
Almost all sedatives cause respiratory depression (most patients can normally compensate)
What should be ascertained about asthmatic patients before they receive sedation?
What drugs do they take- how often
Have they been hospitalised
Can it be exacerbated by stress
What is the issue with patients with psychiatric disease and sedation?
Difficult group to treat in general
Benzos and antidepressants have synergistic effect in causing respiratory depression
What is a pharmacodynamic interaction? Give examples:
Interactions between drugs which have similar or antagonistic pharmacological effects or S/E’s (predictable)
Antidepressants/Antihypertensives and benzos
What is a pharmacokinetic interaction?
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)
Why is sedation generally avoided in pregnant patients?
Theoretical risks of teratogenicity (not proven)
Risk of sedative effect on baby and drug being released via lactation
What can be examined generally when evaluating anxiety?
Eye contact
Speech
Interaction with surroundings
Clinical signs
Vital signs
What aspects of dentistry may make a patient anxious?
Mirror
Gloves
Radiographs
Surgery
Chair-being laid back (loss of control)
Surgeon
Which vital signs are monitored in sedation?
HR
BP
Oxygen saturation
How is BMI calculated?
Weight in kg over height in metres squared
BMI classification:
Less than 18.5 = Underweight
Between 18.5 - 24.9 = Healthy Weight
Between 25 - 29.9 = Overweight
Over 30 = Obese
What is the cut off BMI for sedation?
35
-> issues with resuscitation if chair breaks
What is the cut off weight for dental chair?
28 stone
What side effect of sedation is it important to remind the patient of?
Amnesia
How can a patient worried about lack of control be reassured?
Remind them that they can stop at any moment and will have ability to do so
What can be done to help a patient feel more comfortable about their treatment with sedation?
Written pre/post op instructions
Introduction to staff and surgery
Opportunity to ask questions
Thorough consent process
Appointment being soon after assessment (avoid overthinking)
