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Pain Control II > monitor during sedation > Flashcards

monitor during sedation Flashcards

1
Q

advantages of oral sedation

A 
universal acceptability
easy to administer
low cost involved
reduced adverse reactions
decreased severity of adverse reactions
no special equipment needed
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2
Q

disadvantages of oral sedation

A

1!! – reliance on patient compliance

prolonged latent period (first pass effect)

erratic absorption from the GIT

inability to titrate

inability to readily lighten or deepen the level of sedation

often prolonged duration of action

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3
Q

prescribe oonly

A

the dose for the patient to take prior to proceudre

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4
Q

bioavailability

A

most orally administered drugs have a latent period of approx. 30 minutes – at this time the blood (plasma) level of the drug in at the minium (therapeutic) level

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5
Q

factors acting to influence absorption of the drug from the GI tract

A 
1. lipid solubility 
ph of gastric tissues 
mucosal surface area 
gastric emptying time
dosage form of the drug 
drug inactivatin 
presence of food in the stomach 
bioavaliability 
hepatic first pass effect
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6
Q

anxiety implication

A

can delay gastric empting – by as much as 2x – which will DELAY THE ONSET of action of antianxiety drugs

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7
Q

administer in oil or aqueous solution

A

more readily absorbed if given with aqueous solution over oily or capsule form

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8
Q

primary use of oral / rational

A

managment of anxiety before the dental procedure

strongly suggested that only minimal to moderate sedation be sought via oral route

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9
Q

contrainidaction for oral sedative

A

dentist must be cpaable of prompt recognition and managment of any adverse reaction that might develop

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10
Q

titration by appointment means

A

dentist will assess the efficacy of sedation achieved t the first appointment with a given dosage and if necessary, increase or decrease the dosage of drugs administered at subsequent appointments
- over a period of 2-3 appointments 0 the appropriate dosage for that patient can be achieved / titrated

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11
Q

antianiety drugs produce sedation?

A

no - but level of control over the anxiety of the patient

  1. antianxiety drugs
  2. edative -hypnotics
    - benxo’s
    - nonbenzo’s
  3. histamine blockes
  4. opiod analgesics
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12
Q

benzo important fact

A

effective dose and lethal dose is a smaller margin than compared to benzo

LOWER MARGIN OF SAFETY

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13
Q

lower doses of these drugs produce

A

calming effect (sedation) usually associated with a degree of drwosniness and motor incoordination (ataxia) whereas higher dosages produce hypnosis – state resembling physiologic sleep

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14
Q

examples of benzos used

A 
fluraxepam
temazepam
triazolam 
lorazepam
midazolam
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15
Q

non benzos are

A

zoldiem
zaleplon
eszopiclone

chloral derivatives
- chloral hydrate

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16
Q

most popular and common class and effective drug for managemnt of dental fear and anxiety

A

benzo’s antianxiety agents

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17
Q

benzos act where

A

subcortical levels of the CNS – actions on limbic system + thalamus

doses smaller than those depressing the reicular activating system - and the cerebral cortex –

  • barbs and other s do NOT exhibit selective depression, producing a more generalized CNS depression
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18
Q

benzo in dentistry for

A

MINIMAL TO MODERATE SEDATINO – DRUG OF CHOICE VIA THE ORAL ROUTE

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19
Q

give ___ the night before

A

flurazepam and triazolam

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20
Q

give ___ pre treatmetn

A

oxazepam (acitve metaboite or valium / diazepam) and diazepam

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21
Q

valium aka

A

diazepam

high safety index
anticonvulsant
skeletal muscle relaant
respiratory nd cardiac depression

has an active metabolite – oxazepam

peak 1 hour

dose 5-10 mg 1 hour before tx

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22
Q

contraindications to valium / diazepam

A

allergy, psychoses, acute narrow angle glaucoma, pregnancy age under 6

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23
Q

versed aka

A

midazolam

more potent than valium . diazepam

oral dose = ,5 mg / kg

expensive

water soluble

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24
Q

triazolam aka

A

halicion

no active metabolites
dose is .125 - 5 mg (.25mg)

anxiolysis

sleep

rapid onset - peak 1 hr

antergrade amnesia

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25
Q

alprazolam aka

A

xanax
dosage .25 - 1.0 mg

onset 1 hour

duration 1-2 hours

contraindications
- allergy
acute angle glaucoma
glaucoma

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26
Q

non benzos mainly used for

A

zolpidem (ambien)

zaleplon (sonata)

zopiclone (imovane)

given for anxiety / cant sleep – before any other sedation is given

27
Q

benzo ANTAGONOIST

A

flumazenil

competes with beno for the receptr site

uses - reverse CNS respiratory depressant effects
- decrease recovery time

usual dose – .2mg IV over 15 seconds

additional .2 mg prn
repeat q 5 min until recovery or total dose of 1 mg

28
Q

benadryl / diphenyhydramine

A

antihistamine with side effect of sedation
- more commoly used with CHILDREN

peak 1 hour
duration 4-6 hours

dose 12.5 - 25 mg

elixir - 12.5 mg/5ml teaspoon

29
Q

absence of pain the effect of opioids?

A

produce dyphoria instead of sedation

30
Q

select medication based on __ and not_

A

best suit patients age, weight, and medical history, RATHER THAN solely based on the length of time required for the dental tx

prudent to start with a shorter appointment and with treatment that is not too invasive in order to gauge the appropriatness of the chosen sedative agent

amount administered should always be the lowerst effective dose

31
Q

use __ for 1 hour procedures

A

zaloplon

32
Q

moderate length 1-2 hours use

A

triazolam (halcion) - short acting benzo in the dose of .125 -.5 mg can be given 1 hour before the procedure

33
Q

2-4 hours

A

lorazepam (ativan) longer acting can be used

34
Q

oral sedation appointment - adult patient

A

previous visit – the suitability of oral sedation is deterimined

day of appt.

  • arrive 1 hour before
  • sedative drug administered with water
  • monitor to start
  • wait 45 min then evaluate
  • have accompany at all times
  • monitors and vtal taken / t minuts

SUPINE

use of nitrous can be considered

good local anesthesia

discharge with escort

courtesy call after

35
Q

monitoring includes

A

vitals from start to finish and also recording everything

routine preoperative monitoring
recordkeeping

36
Q

monitoring can

A

permit early detection of adverse side effects that may be produceed by drugs or by clinical actinos, inlcuding hemorrhage or underventilation and
allows corrective measures – to be institutted at a time when they are more likely to be effectiveely prevent serious complications from developing

treating urgency – can prevent treating and emergency

37
Q

when can a apparatus be considered a monitor

A

only when it delivers an AUDIIBLE or VISUAL warning when the function measured falls outside of predetermined parameters

if no warning - the device is more a measuring instrument than a monitor

38
Q

monitors designed to measure

A

CNS
respiratory system
cardiovascular system
temperature

39
Q

requiremnts of ideal monitoring devices

A 
safe
reliable
noninvasive
easily interpreted display 
easy to calibrate
stable
portable
inexpensive 
no technical aid required
easily integrated with other monitoring equipment
40
Q

vital signs pre op must be

A

blood pressure
heart rate and rythm and respiratory rate

additional - temp, height and weight

41
Q

pulse tells you

A

heart rate and rhythm

42
Q

pulse recommended for

A

ALL patients as part of their routine preoperative evaluation
values below 6- or greater than 110 beats per min in adult - should be re-evaluated before tx is started

43
Q

monitor of pulse?

A

regular intervals is DESIRABLE during parenteral sedation - every 15 minutes or every 5 minutes

continous monitoring of the pulse is MANDITORY for all forms of deep sedation and GA where more profound levels of CNS depression is sought

44
Q

radial pulse palpable?

A

systolic pressure at least 80

brachial - at least 70

carotid - atleast 60

if both carotid and brachial pulses are present but radial is not - systolic pressure is greater than 70 but less than 80 mm Hg

45
Q

monitoring blood pressure is ___ method

A

second method

46
Q

asa 4 wit

A

200 mm hg systolic or 115 mm hg disatolic or higher

requires medical consultation and management BEFORE the start of elective dental or surgical care

47
Q

blood pressure cuff on same with IV line?

A

NO
cause machine will constrict them in that area

same with pulse oximeter – not on the same arm

48
Q

intra arterial blood pressure use?

A

degree of accuracy is great but not reall needed during outpatient sedation

indicated in both GA procedures involving a greater degree of risk - neuro or cardiac surgery and when the degree of risk pesented by the patient (ASA 4 or 5) is significant

49
Q

ECG use

A

monitors noth heart rate and rhythm and provides warning of development of changes in the elctrical activity of the myocardium

standard lead I (right arm – left arm) or lead II right arm – left leg are most commonly used during anesthesia b/c they permit excellent detection during dysrhythmias

50
Q

what can you NOT use for respiration monitoring

A

rise and fall of the chest and color of the oral mucous membranes

51
Q

respiratory monitoring device

A

precordial - pretracheal stethescope

52
Q

two things to consider with breathing

A

rate and soun

53
Q

tachypnea

A

indicates presence of anxiety – hyperventilation - pathologic condition – diabetic acidosis and ketosis or elevated CO2 levels

54
Q

bradypnea

A

noted after administration of larger doses of the opioid agaonist analgesics

55
Q

snoring cause and magemnt

A

hypopharngeal obstruction by the tongue

repeat head tilt and chin lift

56
Q

gargling cause and managment

A

foreign matter (blood / wtaer , vomite in airway

suction airway

57
Q

wheezing cause and management

A

brochospasm

bronchodilator - via inhalaton - only if conscious IM, IV i unconscious

58
Q

crowing cause and mamangement

A

laryngeospams - partial

manage - suction airway + ressure O2

59
Q

he thinks ___ is most essential in monitoring

A

pulse oximetry

60
Q

appearance of dysrythmias with ECG can be due to

A

during sedation can be due to
hypoxia - leading to myocardial ischemia and
endogenous catecholamine release - secondary to inadequate pain control or too light level of CNS depression

61
Q

hypoxia levels

A

arterial O2 saturatino SpO2 of 8^% to 90%

- unsuspected hyoxemia occurs more than we think – study showed 53% in this rang

62
Q

O2 saturation refers to

A

amount of O2 carried by hemoglobin

HbO2 and Hb absorb wavelnegths of light at differing degrees - relative percentages of these two hemoglobins ae calculated within the oimeter, and the SpO2 is displaye don the screen

63
Q

carbon dioxide monitoring

A

monitor levels of
uses infrared absorption

inspired and end tidal CO2
displays a % or mm HG

audible and visual alarms alert the operator if end-tidal CO2 calues are less than or greater than the selected parameters
less than 23 mm Hg or 3% or greater than 51% or 6.5% or if apnea occurs

64
Q

implication of temp / fever

A

can increase the workload of the cardiovascular and respiratory systems

heart and respiratory rates increase with an increase in body temp

the patients ability to tolerate stress decreases

keep recording device in pt. mouth for 3-5 mins

Pain Control II (15 decks)

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