July 15,2021 Flashcards
T/F The manner in which we present ourselves to our patients may be one of the most important habit to develop?
T- may be a source of dental anxiety
Basic dental fears
Fear of pain, unknown, helplessness and dependency, body mutilation, death.
T/F Management of anxiety begins with recognition
True
What decreases out pain threshold
Anxiety
Stages of general anesthesia
Stage I - Analgesia
Stage II - Delirium
Stage III - Surgical anesthesia
Stage IV - Respiratory paralysis
What stage does conscious sedation occur in?
Stage 1 analgesia
What occurs in stage 1-analgesia?
Respirations are normal Eye movements are normal Protective reflexes are intact Amnesia may or may not be present Begins with administration of CNS depressant and ends with loss of consciousness Remains conscious throughout Affects cerebral cortex Conscious sedation
What occurs in stage 2 delirium?
Loss of consciousness
Irregular respirations
Responses to stimuli exaggerated (laryngospasm)
Amnesia
Respirations irregular…become regular in stage III
Eyeballs oscillate involuntarily (lateral nystagmus)
Pupils react to light normally
Muscle tone is increased
Protective reflexes quite active…become more obtunded as stage progresses
What occurs in stage 3-surgical anesthesia
Most surgeries take place in this stage
Respirations are regular
Muscle tone is lost
4 planes categorized by respirations, eye movement, protective reflexes, reaction of pupils to light
What occurs in stage 4- medullary paralysis?
Begins with respiratory arrest and ends with cardiac arrest
Rarely sought intentionally
What is Iatrosedation?
A technique of communication between the doctor and the patient that creates a bond of trust and confidence
Truth
Other nondrug psychosedative techniques
Hypnosis Acupuncture Acupressure Audioanalgesia Biofeedback Electroanesthesia (tens) Electroanesthesia (ea) Electronic dental anesthesia (eda) Electrosedation
Oral route sedation onset and peak of duration?
30 minutes and 60 minutes
What is drug titration?
Titration is defined as the administration of small incremental doses of a drug until a desired clinical action is observed
Is rectal administration of sedative drugs recommended?
No. Use of antiemetic use maybe
Topical administration of medications usefullness?
Absorption through skin is poor
Mucus membrane is better
What sedative drugs administered via sublingual for pediatric patients?
Triazolam
Disadvantages of subcutaneous administration of medications?
Delayed onset of action due to delayed absorption
Advantages and disadvantages of intra-musculature administration of sedative drugs?
Advantages
More rapid onset than enteral
Maximum clinical effect in about 30 minutes
More reliable absorption
Disadvantages
Injection is necessary
Prolonged duration
No titration
Advantages and disadvantages of intravenous sedation?
Advantages
Most reliable/effective
Short latent period
Disadvantages
Can’t decrease level of sedation after medication is injected
Some medications can be reversed, but not all
What reflexes do patient loose in general anesthesia?
All protective reflexes and loss of consciousness. Pt no longer responsive. Must have extensive training to undertake GA.
What is Iatrosedation?
Relief of patient’s anxiety through doctor/staff behavior. and doc/staff have a profound effect on pt behavior.
Pain that is expected and considered normal does not hurt as much. More anxiety when feel pain that isn’t expected versus pain that is expected. Must communicate w/patient even when sedated.
Goal of Iatrosedation?
Reduce patient need for pharmacological sedation interventions.
Open lines of communication between patient and doctor
What happens when you prepare for an emergency?
The emergencies begin to stop
What do you do when you are unable to control a patient’s behavior?
Stop and be happy. This should not be considered a failure.
