Pain and Anxiety Control Flashcards
Definition of Conscious Sedation:
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to understand and respond to verbal commands. “Deep sedation” in which these criteria are not fulfilled must be regarded as general anaesthesia.
In the case of patients who are unable to respond to verbal contact even when fully conscious the normal method of communicating with them must be maintained.
Which medical conditions can be aggravated by dental treatment stress and would indicate treatment with sedation?
Ischaemic heart disease
Hypertension
Asthma
Epilepsy
Psychosomatic illness (somatoform disorders)
Misc conditions- Ulcerative colitis, Crohn’s disease etc
Which medical conditions can affect cooperation and would indicate treatment with sedation?
Mild to moderate movement or learning difficulties
Spasticity disorders
Parkinson’s disease
Which psychosocial conditions may indicate treatment with sedation?
Phobias- Things in mouth, Dental Procedures, Needles, Drills
Gagging
Persistent fainting/ Idiosyncrasy to LA
Why is sedation effective in treating patients who suffer from gagging?
IS can suppress the gag reflex
What is a phobia?
An irrational and uncontrollable fear, which is related to a specific object or situation. It is persistent, despite avoidance of the provoking stimulus. It has a direct effect on the patient’s lifestyle.
What are the causes of dental anxiety?
Trauma - primary traumatic experience (usually in childhood- may be cumulative)
Transference (learned)-parenteral, playground
Fear of Criticism
Fear of Dress
Lack of communication
Helplessness
Causes of dental anxiety continued:
Invasion of body orifice
Influenced by environment
Surgery appearance
Staff continuity
Age
Stage of Development- Young and Old, learning difficulties, young adults
Gender
Socioeconomic group
What are the dental indications for sedation?
Difficult or unpleasant procedures
->Surgical extraction of wisdom teeth
->Orthodontic extractions (lack of treatment experience)
->Implants
What are the medical contraindications to sedation?
Severe or uncontrolled systemic disease
Severe mental or physical disability
Severe psychiatric problems
Narcolepsy- fall asleep (risk of deep sedation)
Hypothyroidism
ASA Classification:
- A normal healthy patient
- A patient with mild systemic disease
- A patient with severe systemic disease
- A patient with severe systemic disease that is a constant threat to life
- A moribund patient who is not expected to survive without the operation
6.A declared brain-dead patient whose organs are being removed for donor purposes
What are the medical contraindications for IV sedation?
Intracranial pathology
COPD
Myasthenia gravis
Hepatic insufficiency- poor metabolism of drug
Pregnancy and lactation (transfers to child)
What is Myasthenia gravis? Why is IV sedation not appropriate?
Muscle wasting disorder
->You do not want to weaken muscles further using sedative muscle relaxants as it can affect breathing
Which ASA classes can be treated with IV sedation in dental setting?
1 and 2
-> others can be if anaesthetist lead in hospital
What are the medical contraindications for IS?
Blocked nasal airway
COPD
Pregnancy (teratogenic?)
