IV Sedation for XLA

Question 1

How can dental anxiety be assessed?

Answer 1

Questionnaires - modified dental anxiety scale

Question 2

What are options for managing pt with dental anxiety?

Answer 2

Mild anxiety - LA and behaviour management
Moderate - IHS/ IV
Extreme - GA

Question 3

How to assess if pt is suitable for IV sedation?

Answer 3

ASA for pt
BMI
Vein assessment

Question 4

How can ASA 1 or 2 be managed?

Answer 4

Managed in primary care

Question 5

How should ASA 3+ be managed?

Answer 5

Usually in secondary care

Question 6

Is older age a CI for IV sedation?

Answer 6

Age is not an absolute CI but older pt are more sensitive to sedation and may have poorly tethered/ friable veins

Question 7

How to explain IV sedation?

Answer 7

Form of conscious sedation - alters consciousness enabling tx to be carrie out. Awake enough to maintain verbal contact
Advised need escort

Question 8

What drug is used for IV sedation?

Answer 8

Benzodiapezine - midazolam

Question 9

What pt take caution w/ w/ midaozlam?

Answer 9

Liver disease - midazolam metabolised in liver by cytochrome p450

Question 10

What is observed during iv sedation?

Answer 10

Blood pressure, hr and oxygen saturation

Question 11

What is reversal drug for midazoam?

Answer 11

flumazenil

Question 12

Can pt be given pre-medication prior to IV sedation?

Answer 12

Possible to prescribe oral benzodiazepine
Remember premeditated pt is unable to give consent - need to give prior to procedure

Question 13

What is a pre-operative medication can prescribe?

Answer 13

Diazepam - 5mg tablet, taken 2 hours prior to procedure

Question 14

What are possible complications of IV tx?

Answer 14

Oversedation - decreased respiratory rate

Question 15

How can dentist provide IV training

Answer 15

Need accredited training - need at least 20 cases of supervised sedation