Lesson 1 Sedation and anaesthesia

Question 1

What is the role of sedation in dentistry?

Answer 1

pt manadgement and reduce complications caused by anxiety/panic attacks

Question 2

What is the role fo anaesthesia in dentistry

Answer 2

like sedation, but for uncooperative and other groups, or if tx inappropriate for LA and therefore sedation

Question 3

why is midazolam safe?

2) what type of sedation is it used in?
3) Is the pt responsive while having IV?

Answer 3

large therapeutic window use midazolam (o.5mg sedated but for anaesthetisia requries 25/30g.)
AND
flumazenil is available when midazolam is used, to reverse the effects if necessary.
2) conscious sedation
3) respond to verbal cues e.g. open eyes

Question 4

How is conscious sedation carried out in an adult?

BNF

Answer 4

slow IV
For Adult
Initially 2–2.5 mg, to be administered 5–10 minutes before procedure at a rate of approximately 2 mg/minute, increased in steps of 1 mg if required, usual total dose is 3.5–5 mg; maximum 7.5 mg per course.

Question 5

How is conscious sedation carried out in an elderly?

Answer 5

slow IV
Initially 0.5–1 mg, to be administered 5–10 minutes before procedure at a rate of approximately 2 mg/minute, increased in steps of 0.5–1 mg if required; maximum 3.5 mg per course.

Question 6

What is the definition of sedation?

Answer 6

1) The reduction or abolition of the physiological and psychological responses to the stress of dentistry, without loss of consciousness, cooperation or protective reflexes
Protective reflexes: airways

Question 7

what are the different types of psychic and somatice sedation?

Answer 7

1.Oral
2.Inhalation
3. Intravenous
4. Rectal
5. transmucosal (nasal (sprays) and buccal mucosa)
+Analgesia

Question 8

What is the first line oral sedation?

2) what is the 2nd line?

Answer 8

1) Midazolam

2) Temazepam

Question 9

What is the first line inhalation sedation?

2) what is the 2nd line?

Answer 9

Nitrous Oxide/oxygen
(with this one it has small analgesic properties so LA is not required is its a small occlusal filling)
2) Sevoflurane (studies show more effectiveness when combined with NO with O or O than them alone, but sedationist required and specialist equipement not available in primmary care.

Question 10

1) What is the first line for intravenous sedative?
2) 2nd line?
3) other options?

Answer 10

midazolam
2)opoid and midazolam. technique where
a single small dose of an opioid
(usually fentanyl) is followed by
a titrated dose of midazolam.
It is used for patients for whom
midazolam alone does not
produce adequate anxiolysis
3) ketamine  in paediatrics ( little evidence. AND Midazolam and propofol

Question 11

What is the problem with oral sedation?

Answer 11

Oral
techniques are not titratable
and should only be used when
titratable sedation techniques are
inappropriate.

Question 12

What drug is used in intranasal sedation?

Answer 12

Midazolam

Question 13

what drug is used for target-controlled infusion sedations?

Answer 13

Targetcontrolled infusions of propofol
are widely used for sedation
in many medical and dental
fields. These techniques require
the presence of a dedicated
sedationist

Question 14

what technique should be used for sedation in pts with tolerance to benzodiazepines?
2) why is this drug not as safe?

Answer 14

propofol target-controlled infusion sedations

2) smaller therapeutic window therefore adverse effect more likely

Question 15

who is needed for : Targetcontrolled infusions of propofol

Answer 15

sedationist

Question 16

who can give GA?

Answer 16

anaesthetists

Question 17

Dentists can carry out GA

true or false

Answer 17

false

Question 18

a pt asks for GA, what do you do next?

Answer 18

try a less invasive method, sedation

Question 19

What are social indications for sedation?

Answer 19

1) Phobias(Things in the mouth
Dental procedures
Needles
Drills)
2) Gagging
IV sedation = effective to remove gagging reflex
3) Persistent fainting

Question 20

What are medical indications for sedation?

Answer 20

ischaemic heart disease e.g. angina
asthma
high blood pressure (hypertension)

Question 21

What are dental indications for sedation?

Answer 21

surgical MOS
impacted 3rd molars
implants

Question 22

Who can’t you give sedation to?

2) who can’t you give IV sedation to?

Answer 22

1) uncooperative
unaccompanied
2) very old (liver and kidney cautious due to metabolism
very young (sensitive to dosage)

Question 23

Young child who is restless in chair requires multiple fillings. what do you do?

Answer 23

uncooperative therefore GA

Question 24

What are the medical contraindications for sedation?

Answer 24

1) severe or uncontrolled systemic disease (especially cardiac e.g. recent MI, COPD)
2) hepatic or renal insufficiency (look out for jaundice), won’t metabolise drug)
3) pregnancy and lactation ( should not have sedation, IV sedation= into breast milk= sedated baby)

Question 25

Dental indications to not carry out under sedation?

Answer 25

cyst presence
implant placement (30 mins per implant)