IV Sedation II

Question 1

Purpose of sedation?

Answer 1

Control of fear/ anxiety
Reduce stress
Control gag reflex
Tx of un-co-operative pt

Question 2

Advantages of IV sedation?

Answer 2

Remote from operating site
Rapid onset 
Pt co-op less important 
Amnesia 
Mouth breathing not important

Question 3

Disadv of IV sedation?

Answer 3

Analgesia not clinically useful
Overdose - resp depression
Disinhibition effects
Sexual fantasy

Question 4

Pathway of pt management in anxiety?

Answer 4

Time/ TLC –> psychotherapy –> hypnosis/ acupuncture –> IHS –> oral sedation –> IV sedation

Question 5

Social issues w/ providing IV?

Answer 5

Need responsible escort
Following post-op instructions
Time off work/ child care

Question 6

What is ASA?

Answer 6

American society of anaesthesiologists physical status rating

Question 7

What are 5 ASA ratings?

Answer 7

I = normal healthy pt
II = mild to moderate systemic disease
III = severe systemic disease, not incapacitating 
IV = severe systemic disease, threat to life
V = moribund pt not expected live 24 hr w/o intervention

Question 8

Which ASA scale would be contraindication dental tx?

Answer 8

IV/ V

Question 9

Why key to obtain consent prior sedation?

Answer 9

Can’t consent when sedated

Question 10

What to do if pt unable consent?

Answer 10

Talk next of kin/ discuss w/ care staff
2 professionals independently agree tx in pt best interest
Appoint independent mental health capacity advocator

Question 11

What is included in baseline physical exam prior IV?

Answer 11

Pulse
Respiration levels
Oxygen sats
Blood pressure
Weight/ BMI

Question 12

What are the 6 effects of benzodiazepine

Answer 12

SAD AAH

Sedation
Anxiolytic
Decrease skeletal muscle tone

Amnesia
Anticonvulsant
Hyponosis

Question 13

Contraindications IV sedation?

Answer 13

Allergy benzodiazepine
Poor veins
Sleep apnoea
Pregnancy 
High BMI 
Hepatic impairment 
Extreme of age
ASA III,IV,V
Pulmonary insufficiency

Question 14

Main issues with drug interactions and sedatives?

Answer 14

If drug has sedative effect as well - prolonged and profound sedation
Drug increases respiratory depression
If metabolism of midazolam is inhibited

Question 15

Example of drugs contraindicated with midazolam

Answer 15

Clarithromycin
Erythromycin
Fluconazole/ ketoconazole

…mycin (macrolides)
…azole (triazoles)
…navir (protease inhibitors)

Question 16

What common medications can have enhancive effect on midazolam?

Answer 16

Anti-histamines
Anti-psychotics
Beta-blockers

Question 17

How manage pt on medication prior IV?

Answer 17

Check BNF

Question 18

What to set up before pt arrive for sedation?

Answer 18

Midazolam - check date/ batch
Saline
Straight filter needle draw drug 
Pre injection swab
Tagaderm
Cannula - 22G
Ampoule opened
Tourniquet

Question 19

What emergency equipment should be available?

Answer 19

Oxygen (emergency oxygen) - 15L/min
Suction and non-mains powered suction
Emergency drugs inc flumazenil

Question 20

What temp is considered normal when monitoring pt?

Answer 20

36-37.5

Question 21

What expect pulse rate of be?

Answer 21

70 bpm

Question 22

What expect respiration rate to be?

Answer 22

12-20

Question 23

What expect BP to be?

Answer 23

120/80

Question 24

What check when monitoring pt when sedated?

Answer 24

Colour - check cyanosis
Pulse
Respiration rate
Temp

Question 25

What test before pt fit to leave?

Answer 25

Romberg test - stand unaided with eyes closed

Question 26

What signs would make you suspicious of respiratory failure?

Answer 26

Snoring, paradoxical chest and abode movement, coughing, straining

Question 27

What makes pt more prone respiratory failure?

Answer 27

Tumours
Stricture
Restricted jaw opening

Question 28

What value should trigger alarm on oxygen-haemoglobin dissociation curve?

Answer 28

If falls below 90%