paediatric sedation Flashcards
what is the definition of conscious sedation
- technique in which the use of a rug produces a state of depression of the CNS enabling treatment to be carried out, but during which verbal contact with pt is maintained throughout
what is the goal of conscious sedation
- provide pharmacological materials to augment behavioural management to reduce anxiety levels while maintaining a response from pt
4 factors to pt assessment
- history
- pt factors
- goals
- treatment plan
how can pain affect tx
- can affect timing and options of treatment
- often underlies anxiety = fear makes pain worse
what are some pt factors that determine tx
- understanding
- co-operation
- coping style
what are the 2 coping styles
- monitoring or blunting
order of treatment plan
- non-pharmacological behaviour management
- local anaesthesia
- sedation
- general anaesthesia
how is nitrous oxide stored
- as a liquid in cylinder at 750 pounds per square inch which is 43.5 bar until all liquid evaporates
what age can manage inhalation sedation
- need to be able to understand concept of nasal brething
- > 7y/o but varies with each child
what level of anxiety can manage inhalation sedation
- mild to moderate
what medical conditions can sedation help with during tx
- good for conditions where anxiety can worsen them, such as asthma
what dental needs are good when considering inhalation sedation
- if multiple quadrant treatment needing done
- good for procedures which are a bit more difficult
- good for orthodontist extractions on pts who have had no previous dental experience
what ages are too young for inhalation sedation
- if can’t understand concept
- generally <7 y/o
what anxiety can’t be managed with inhalation sedation
- extreme
what medical conditions are a contra-indication to inhalation sedatoin
- intellectually impaired, developmental delay, learning difficulties
- if a mouth breather
- claustrophobic as having a mask on nose makes it worse
- severe psychiatric disorders, pregnancy, myasthenia gravis
what are the pre and post-op instructions for inhalation sedation
- let them know how they will feel = get some tingling
- reassure back to normal after 5/10 mins post treamtnet
- can’t have pregnant adult accompany child on the day
- no big meals beforehand
- if has a blocked nose can’t get it done that day
- child needs to be supervised by responsible adult for the rest of the day
technique of giving inhalation sedation
- calming voice
- get child to place nasal hood on and then make sure it is fitted properly
- tell pt a story to relax them and meanwhile turn flow of o2 to match child’s tidal volume (watching reservoir bag)
- slowly start reducing o2 to increase nitrous oxide
- keep talking-to pt
- ensure child avoids mouth breathing
- once finished treatment turn back to 100% o2 and let them breathe that for at least 2 minutes before removing mask
how to reduce o2 and increase nitrous oxide
- start with 100% o2
- after 1 minute drop by 10% o2 then after another minute drop by another 10%
- once down to 80% o2, then start dropping by 5% every minute instead
how to know when child has had enough inhalation sedation
- maximum when child reports tingling or starts giggling/becomes over-excited
- stop if ears are ringing or sore head
what drug is more commonly used for IV sedation in children instead of midazolam
- propofol
advantage of post procedure amnesia from sedation
- if it was quite invasive then good as pt can’t remember it
disadvantage of post procedure amnesia from sedation
- can’t remember how well they done which then doesn’t help them build their confidence for future dental treatment
what age can have IV sedation
- adolescents and up
what anxiety level is good for IV sedation
- moderate to severe anxiety
what age is too young for IV sedation
- <12
what anxiety level is no good for IV sedation
- mild = no need
- severe needle phobia
what pts are not good for IV sedation
- those who like to monitor what you re doing because no good with amnesia effect
- pts who struggle with lack of control
what is TCI propofol
- target controlled infusion
- potent IV anaesthetic
- change and maintain pre-set plasma concentration of propofol because plasma propofol radially equilibrates the brain and seditionist can continually titrate plasma propofol concentration depending on level of sedation
- administered by sedationist
- useful for very long and very short procedures = alters memory of time
- rapid onset and rapid recovery = low dose agent
what can child not do after IV sedation
- nothing strenuous or dangerous for 24 hours
- no alcohol, sedative drugs without medical opinion
- shouldn’t make any important decisions
- lack of judgement so be careful with social media
TCI procedure
- at first visit get pre-op checks done (weight, BP, HR)
- child given topical anaesthesia for skin to put on before appointment
- come back and place cannula
- child monitored throughout procedure
- sedative agent administered
- towards end of tx, TCI propofol turned down to 0
- normally pt is alert 10 mins after stopping sedative agent
- recovery checked by anaesthetist and checked child can walk unaided
what are other sedation options
- oral = drink a sedative
- transmucosal = puffed up nose
- these are much less controlled and rarely used
- general anaesthesia
what is the most common reason for children getting GA
- dental procedures
