IVS

Question 1

What are the indications for IVS

Answer 1

Anxiety
Health conditions
Neuromuscular conditions

Question 2

What are the contraindications for IVS

Answer 2

Severe respiratory disease
Severe cardiovascular disease
Pregnancy (not 100%)
Unpredictable metabolism
Personality disorders
Poor veins

Question 3

Why is severe respiratory & cardiovascular disease a contraindication for IVS

Answer 3

Midazolam is a respiratory depressant so anyone who has a decreased respiratory function could become deoxygenated when taking midazolam or it could cause cardiovascular depression.

Question 4

Why is IV sedation contraindicated in pregnancy

Answer 4

Damage to foetus this can be done in 2nd trimester it’s a last resort but has less risks than GA. Pt must express before op as to not sedate baby after op if breastfeeding

Question 5

Why is IV sedation contraindicated in children

Answer 5

Unpredictable outcomes, opposite effect as desired and unpredictable outcomes.

Question 6

Why is unpredictable metabolism contraindicated in IV sedation

Answer 6

Hepatic or renal impairment changes drug metabolism and profanity/duration of action. Tolerance will increase dose required for desired effect

Question 7

What is the half life of midazolam

Answer 7

1.9h + - 0.9h

Question 8

What is the max dose of midazolam and in what concentration do you get it

Answer 8

17.5mg
1mg/1ml

Question 9

What should be done in a pre assessment for IVS

Answer 9

General assessment
Medical assessment
Dental assessment
Decision and treatment plan
Give written pre and post op instructions

Question 10

What are the ASA (American Society for Anaesthesiology) classification

Answer 10

1 normal pt
2 mild/well controlled systemic disease
3 sever systemic disease
4 severe systemic disease with constant threat to life (unstable angina)
5 moribund patient needing operation to survive
6 brain dead having organs taken for donor purposes

Question 11

When should pre op be done

Answer 11

At a different appointment to operation unless it’s and emergency

Question 12

What should be done just before operation

Answer 12

Check general obs
Check MH
Check consent
Check carer

Question 13

What is checked in general obs

Answer 13

General appearance
HR
BP
RR
O2

Question 14

What are the benefits of IVS

Answer 14

Outpatient procedure
Cheaper
Safer than GA
effective

Question 15

Disadvantages to IVS

Answer 15

Retrograde amnesia
Unpredictable in youngsters
Patients may need sedation for all treatments
Think they were asleep last time making second time hard
Increased medical complications
Oral access compromised

Question 16

What are the stages on operation day

Answer 16

Pre assess
Pre op checks
Pre op prep (drugs and stuff)
IV access
Sedation
Clinical procedure
Recovery

Monitoring is carried out from when drug is administered

Question 17

What is a timer used for in IVS

Answer 17

Time from when drug was administered

Question 18

When can cannula be removed

Answer 18

60 minutes after last midazolam dose

Question 19

What happens to vitals after midazolam administration

Answer 19

Shallower slower breaths
Reduced heart rate

Question 20

What do you expect vitals to be on day of procedure

Answer 20

Elivated HR & BP

Question 21

What should be done if pt is diabetic

Answer 21

Take blood glucose p, this should be above 4 and if it is not the sugary food should be given and this should be retaken above 4 before procedure starts

Question 22

What are the two different sites of cannulation called

Answer 22

Anti-cubital fossa
Dorsum of hand

Question 23

Benefits & disadvantages of anti-cubital fossa

Answer 23

Larger fixed vein less susceptible to climatic vasodilation

Less visible, brachial artery & median nerve very close

Question 24

Benefits & disadvantages cannulating dorsum of hand

Answer 24

More visible, no delicate surrounding structures, more obvious if in wrong place

Vaisoconstrict if cold
Smaller veins and more painful

Question 25

At what rate do you titrate midazolam

Answer 25

1mg increments waiting 1m between increments. Use 0.5 in young old and ill.

Question 26

What is midazolam antidote

Answer 26

Flumazenil, is only used in emergencies & it’s half life is much less than midazolam so sedative effects come back after it wears off before midazolam

Question 27

What is Flumazenil dose and titration rate

Answer 27

Max dose 1mg titrate 0.2mg over 15s and then wait 1minute between increments

Question 28

What veins do we cannulate in the anti cubital fossa.

Answer 28

Cephalic vein
Basilic vein

Question 29

When is
O2 saturation a worry

Answer 29

When it falls below 95% if it does supplement with nasal cannula.

Question 30

What are some issues with O2 monitors

Answer 30

Average so don’t detect acute manifestations quickly and often give a higher than true reading

Question 31

What causes oxygen to stick to haemoglobin more

Answer 31

High pH
Low CO2
Low temp

Question 32

What causes oxygen to dissociate more quickly

Answer 32

Low pH
High CO2
High temp

Question 33

What happens to heart rate after administration of local anaesthetic when sedation monitoring

Answer 33

Increased caused by stress anaesthetic and adrenaline

Question 34

What can’t an O2 monitor direct

Answer 34

Anaemia hypoxia
Cytotoxic hypoxia

Question 35

What is anaemia hypoxia

Answer 35

Good Haemoglobin saturation just not enough haemoglobin to supply tissues

Question 36

What is cytotoxic hypoxia

Answer 36

Cyanide or carbon monoxide poisoning stop cells being able to use O2