Patient selection for IV sedation

Question 1

What are the indications for intravenous sedation

Answer 1

Patients who have:
1. Moderate to severe Anxiety
2. General health issues
3. Neuromuscular problems
4. Extensive procedures

Question 2

What can patients be anxious regarding

Answer 2

1. Dental procedure
2. Local anaesthetic
3. Clinical environment
4. Needle phobia
5. Pain

Question 3

What can severe anxiety sometimes lead to

Answer 3

Can contribute to local anaesthetic failure

Question 4

How can some general health issues be an indication for sedation

Answer 4

If in that condition we want o avoid giving the patient undue stress or anxiety we may opt to go for sedation

Question 5

Give examples of general health issues that may indicate sedation

Answer 5

1. Moderate ischaemic heart disease
2. Mild hypertension
3. Epilepsy
4. Asthma

Question 6

What neuromuscular problems may indicate sedation

Answer 6

1, Excessive gag reflex
2. Some tremors such as Parkinson’s and cerebral palsy

Question 7

What is the half life od midazolam

Answer 7

1.9 hours (+/-0.9hrs)

Question 8

What are the contraindications indications for IV sedation

Answer 8

1. Severe respiratory disease
2. Cardiovascular disease
3. Pregnancy
4. Unpredictable metabolism
5. Personality disorders
6. poor veins

Question 9

Why is IV sedation contraindicated in patents with severe respiratory disease

Answer 9

As IV sedation depresses respiration so patients with who have limited respiratory reserve can easily become deoxygenated under sedation

Question 10

Give examples of respiratory disease that may be a contraindication for intravenous sedation a

Answer 10

1. COPD
2. Extensive lung disease
3. Heavy smokers

Question 11

Give examples of respiratory disease that may be a contraindication for intravenous sedation a

Answer 11

1. Severe ischaemic disease
2. Poorly controlled hypertension
3. Severe arrhythmia

Question 12

Is pregnancy a complete contraindication for IV sedation

Answer 12

No it is preferred to general anaesthetic however if we can wait till the baby is born that is more preferable

Question 13

If we did need to carry out IV sedation on a pregnant patient when would be the best time to book the appt

Answer 13

In the 2nd trimester

Question 14

Do we do IV sedation on children

Answer 14

Not in the UK

Question 15

Why don’t we perform IV sedation on children

Answer 15

1. As the responses are unpredictable
2. Child may lose controlling inhibitions and become uncooperative
3. Can be difficult gaining IV access initially

Question 16

in anxious or indicated children what type of sedation do we tend to use

Answer 16

Inhalation sedation

Question 17

Which patients may have “unpredictable”metabolism

Answer 17

Patients with:
1. Impaired renal or hepatic function
2. Long term drug abuse
3. Allergy to benzodiazepine

Question 18

How can imputed renal or hepatic function lead to an unpredictable metabolism

Answer 18

Metabolism and excretion of sedation drug can be effected in a way we do not know

Question 19

Why are one term drug abusers a contraindication for IV sedation

Answer 19

Their reaction to the sedation drugs can be unpredictable

Question 20

Give examples of personality disorders that can be a contraindication for IV sedation

Answer 20

1. Severe psychiatric disease
2. Learning difficulties if patient can not consent to treatment

Question 21

Give examples of patients with poor veins

Answer 21

1. Patients with excessive subcutaneous fat making the veins not visible
2. Elderly patients with friable veins that are prone to damage

Question 22

How can we gauge if a patient has poor veins

Answer 22

Can ask how easy it is for the patient to have blood tests