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Parenteral Conscious Sedation II Flashcards

1
Q

Patients with these ASA classifications should not be treated with in-office sedation.

A

ASA 3 or 4

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2
Q

Before parenteral sedation, NPO for how many hours?

A

6-8 hours

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3
Q

Can people underoing sedation take needed meds only with water?

A

Yes!

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4
Q

T/F:

Adjustments in oral hypoglycemic or insulin regimen is needed for diabetics undergoing sedation.

A

True

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5
Q

How to prevent hypoxia, bronchospasm, and respiratory failure.

A
  • Supplemental O2
  • ASA I/II patients only for in-office sedation.
  • Avoid deep levels of anesthesia.
  • Postpone the case if the patient has an active upper or lower respiratory infection.
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6
Q

Someone with a BP of 210/something (HTN) feels ok and there’s no evidence of organ damage, this is a hypertensive ______.

A

Urgency.

Don’t treat them.
Tell them to go to the doctor immediately.

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7
Q

If someone with BP of 210/something feels like they’re coming down with the flu and their chest is tight, this is a hypertensive _______.

A

Emergency.

Call 911 and give oxygen while paramedics are coming.

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8
Q

Tx for a hypertensive emergency.

A

Call 911, and give oxygen in the meantime.

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9
Q

Many asthmatics tend to have these.

A

Multiple drug allergies.

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10
Q

You need another informed consent sheet for this in addition to one for the operative procedure.

A

Sedation/Anesthetic

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11
Q

What’s the one risk the dentist always talks to the patient about for IV sedation?

A

Death

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12
Q

Must have this in addition to the practitioner performing the surgical/operative procedure.

A

Properly trained individual who knows sedation.

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13
Q

Monitors heart rate and rhythm

A

ECG

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14
Q

A really bad sign that someone is crashing.

A

Temperature drop

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15
Q

This way of measuring temperature is the easiest, but least accurate.

A

Skin temp

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16
Q

Measure ocygenation

A

Pulse oximeter

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17
Q

Measures ventilation (CO2 levels).

A

Capnometer

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18
Q

Used to listen to breathing in their throat.

A

Pre-cordial stethoscope.

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19
Q

Capnography tells you that the patient has stopped _______ as opposed to stopped oxygenating.

A

breathing

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20
Q

This person’s signature should go on the anesthetic record.

A

Practitioner’s

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21
Q

This score is based on discharge criteria.

A

Aldrete Score

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22
Q

Opioids cause cerebral vasoconstriction or dilation?

A

Constriction

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23
Q

Opioids effect on blood flow in the brain.

A

Decreased (due to vasoconstriction).

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24
Q

Opioid effect on pupils.

A

Pupillary miosis (constriction).

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25
How do opioids effect Histamines?
Cause Histamine release, so you can break out in a rash from taking opioids.
26
Histamine release from opioids can elicit what (besides a rash)?
Bronchospasm
27
Opioids cause peripheral vasoconstriction or dilation?
Dilation
28
Effect of opioids on the chest wall.
Chest wall rigidity.
29
Most potent street opioid.
Fentanyl
30
Has the highest potency of all the opioids, and it's used in a hospital, in a slow drip infusion.
Sufentanyl
31
Reversal agent for opioids.
Naloxone
32
Naloxone MOA
Competitive inhibitor at opioid receptors.
33
What can Naloxone precipitate?
- Dysrhythmia - Myocardial failure - Pulmonary edema
34
Benzodiazepine MOA
Bind to BDZ receptors linked with CNS GABA receptors on postsynaptic nerve endings located in the cerebral cortex and limbic system.
35
Benzos cause what kind of amnesia?
Anterograde (they remember everything from before the anesthesia).
36
CNS properties of benzos.
- Anxiety reduction - Sedation - Anterograde amnesia - EEG changes awake alpha to beta rhythm. - Reduce cerebral blood flow and metabolic oxygen requirements.
37
How do benzos affect cerebral blood flow?
Decrease (like opioids).
38
Benzos affect on metbolic oxygen requirements.
Decrease
39
Benzos can decrease the body's response to this.
Increased arterial CO2
40
Diazepam with propylene glycol and sodium benzoate can cause this.
Phlebitis- irritating to the veins.
41
Benzos' affect on tidal volume.
Decreased
42
Benzos' affect on respiratory rate.
Increased
43
Drugs that are not broken down into active metabolites are ______ from the body quickly.
eliminated
44
Midazolam active metabolites
NONE!
45
Do not use benzos with this kind of glaucoma.
Acute narrow angle
46
BDZ reversal agent.
Flumazenil
47
This sedative agent causes serious dissociative events (hallucinations).
Ketamine
48
This sedative is NOT given to soldiers, ppl with PTSD, rape victims, etc.
Ketamine
49
This sedative blocks CNS N-methy-D-aspartate (NMDA) receptors to cause sedation.
Ketamine
50
This sedative agent does NOT cause respiratory or cardiac depression.
Ketamine
51
This sedative increases airway secretions and salivary flow.
Ketamine
52
Sedative that increases cerebral blood flow, and therefore, intracranial pressure.
Ketamine
53
Causes cerebral vasodilation.
Ketamine
54
Emergence phenomena are associated with this sedative.
Ketamine
55
Ketamine causes this in old people.
Long-term cognitive impairment
56
Receptors blocked by ketamine
NMDA receptors
57
Sedative that binds to GABA receptors.
Propofol
58
Sedative and Analgesic effect of Propofol
No analgesic affect, just sedative (Michael Jackson was given this bc he couldn't sleep at night).
59
Propofol efffect on BP.
Reduces it
60
Propofol side effects.
Vivid dreams with sexual content.
61
Died of propofol overdose.
Michael Jackson
62
Sedatives contraindicated for extremes in age.
Ketamine and Propofol
63
Verrill's Sign
Ptosis (droopy eyelids).
64
What does Verrill's sign indicate?
Sedation
65
Most popular combination of intermittent incremental doses of multiple agents.
Opioid + Benzo Ex: Fentanyl + Midazolam
66
Causes sedation and analgesia.
Opioid
67
Provides anxiolyis, anterograde amnesia, sedation.
BDZ
68
How is Narcotic + BDZ + Propofol administered?
Intermittent incremental doses
69
Sedative given via continuous infusion.
Propofol (via IV)
70
Exam Q: Must do this when combining sedative agents.
Use LESS of each agent.
71
This reduces anesthetic requirements for individual agents, esp BZD's and narcotics.
Nitrous
72
Midazolam is AKA what?
Versed
73
This drug should be avoided in people with prostate hyperplasia.
Diphenhydramine
74
This drug causes fetal abnormalities.
Hydroxyzine
75
This benzo is used in the pediatric population.
Midazolam

Anesthesia (11 decks)

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