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BDS4 sedation symposium > paediatric sedation > Flashcards

paediatric sedation Flashcards

1
Q

what is the definition of conscious sedation

A
  • 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
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2
Q

what is the goal of conscious sedation

A
  • provide pharmacological materials to augment behavioural management to reduce anxiety levels while maintaining a response from pt
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3
Q

4 factors to pt assessment

A
  • history
  • pt factors
  • goals
  • treatment plan
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4
Q

how can pain affect tx

A
  • can affect timing and options of treatment
  • often underlies anxiety = fear makes pain worse
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5
Q

what are some pt factors that determine tx

A
  • understanding
  • co-operation
  • coping style
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6
Q

what are the 2 coping styles

A
  • monitoring or blunting
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7
Q

order of treatment plan

A
  • non-pharmacological behaviour management
  • local anaesthesia
  • sedation
  • general anaesthesia
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8
Q

how is nitrous oxide stored

A
  • as a liquid in cylinder at 750 pounds per square inch which is 43.5 bar until all liquid evaporates
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9
Q

what age can manage inhalation sedation

A
  • need to be able to understand concept of nasal brething
  • > 7y/o but varies with each child
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10
Q

what level of anxiety can manage inhalation sedation

A
  • mild to moderate
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11
Q

what medical conditions can sedation help with during tx

A
  • good for conditions where anxiety can worsen them, such as asthma
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12
Q

what dental needs are good when considering inhalation sedation

A
  • 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
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13
Q

what ages are too young for inhalation sedation

A
  • if can’t understand concept
  • generally <7 y/o
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14
Q

what anxiety can’t be managed with inhalation sedation

A
  • extreme
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15
Q

what medical conditions are a contra-indication to inhalation sedatoin

A
  • 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
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16
Q

what are the pre and post-op instructions for inhalation sedation

A
  • 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
17
Q

technique of giving inhalation sedation

A
  • 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
18
Q

how to reduce o2 and increase nitrous oxide

A
  • 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
19
Q

how to know when child has had enough inhalation sedation

A
  • maximum when child reports tingling or starts giggling/becomes over-excited
  • stop if ears are ringing or sore head
20
Q

what drug is more commonly used for IV sedation in children instead of midazolam

A
  • propofol
21
Q

advantage of post procedure amnesia from sedation

A
  • if it was quite invasive then good as pt can’t remember it
22
Q

disadvantage of post procedure amnesia from sedation

A
  • can’t remember how well they done which then doesn’t help them build their confidence for future dental treatment
23
Q

what age can have IV sedation

A
  • adolescents and up
24
Q

what anxiety level is good for IV sedation

A
  • moderate to severe anxiety
25
Q

what age is too young for IV sedation

A
  • <12
26
Q

what anxiety level is no good for IV sedation

A
  • mild = no need
  • severe needle phobia
27
Q

what pts are not good for IV sedation

A
  • those who like to monitor what you re doing because no good with amnesia effect
  • pts who struggle with lack of control
28
Q

what is TCI propofol

A
  • 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
29
Q

what can child not do after IV sedation

A
  • 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
30
Q

TCI procedure

A
  • 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
31
Q

what are other sedation options

A
  • oral = drink a sedative
  • transmucosal = puffed up nose
  • these are much less controlled and rarely used
  • general anaesthesia
32
Q

what is the most common reason for children getting GA

A
  • dental procedures

BDS4 sedation symposium (7 decks)

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