Medical considerations and drug interactions in sedation Flashcards
What drug is commonly used in IIV sedation?
Benzodiazepines - Midazolam
How do you assess the suitability of a patient for sedation?
-The patient’s degree of anxiety
-The nature of the dental treatment required
-The nature, severity and stability of patient’s medical conditions
What is blood pressure?
Blood pressure is the pressure exerted on walls of the blood vessels by circulating blood.
How does hypertension occur?
Hypertension occurs when blood pressure within the arteries puts too much mechanical stress on the artery walls. This causes the heart to work harder. It also leads to unhealthy tissue growth within the walls of the arteries, and thickening and weakening of the heart muscle.
Why is uncontrolled hypertension a risk factor when carrying out sedation?
The stress associated with dental treatment can lead to high levels of circulating adrenaline. This is turn can result in increased BP and tachycardia . This then increases the workload of the heart. When the cardiac status is already compromised stress may induce an acute exacerbation of a medical condition e.g. stress induced angina (MI).
What is angina?
Central chest pain, discomfort and breathlessness caused by reduced blood flow to the heart muscles
Why is good respiratory function essential in patients undergoing sedation?
Virtually all sedation agents cause some degree of respiratory depression therefore good respiratory function is essential in patients undergoing sedation. Healthy patients with a normal respiratory capacity are able to compensate for the mild depressive effects of sedation drugs si it is not usually of any clinical significance, patients with respiratory disease have less respiratory reserve and can easily become deoxygenated under sedation.
Give four examples of involuntary movement disorders
Cerebral palsy
Multiple sclerosis
Parkinson’s
Huntington’s disease
What is Myasthenia Gravis?
An autoimmune neuromuscular disease which causes weakness of facial and respiratory muscles
Is IHS and IVS suitable for diabetic patients?
Yes, both are suitable for well controlled diabetic patients
What are the complications for a patient undergoing sedation who has adrenal insufficiency?
Response to stress is supressed and may lead to secondary hypertension and diabetes
What are the complications for a patient undergoing sedation with hepatitic or renal disease?
The response is unpredictable.
More sensitive to the drug
May easily become over sedated and take longer to recover
What are the complications for an obese patient undergoing sedation?
Reduced respiratory capacity
Difficult to cannulate
What are the complications for a patient undergoing sedation with intellectual or physical impairment?
Tolerance and response to sedation unpredictable
What are the complications for a patient undergoing sedation with a mental health disorder?
If disorder mild/well controlled – IVS/IHS may be of benefit
If severe - understanding/cooperation altered
