Pre-Sedation assessment Flashcards
in pre sedation assessment, what do we need to find out?
- Reason for sedation (from GDP letter, GP…), know if they are needle phobic or it’s something else
- Expectation of sedation: Patients should know they will be conscious and not put to sleep. Also they should know that LA is still needed
- Fitness for sedation: medically fit
- Likely suitability: e.g, a high BMI patient may not be able to move
- Social circumstances: if they drink lots of alcohol, they will need more medazolam
How is the medical assessment done and what does it include?
- it is in the form of a questionnaire
- General examination (patient may be qualified for IHS rather than iV)
- Pulse, blood pressure, O2 saturation (picks up heavy smokers and respiratory problems in case of decreased saturation)
- BMI – may be a cut-off point – in Leeds we don’t do outpatient sedation for those above 35
- Dental assessment may not be possible at this stage due to anxiety so Extraoral radiographs can be taken
what is the classification used for sedation assessment?
ASA classification
to which patients in the ASA classification would you carry out sedation in practice?
you would only carry out IV sedation for ASA I, maybe II and rarely III as III will need to be referred to hospital
outline what are the first three ASA classification
I: normal healthy patient
II: A patient with mild systemic disease (e.g. well-controlled asthma)
III: A patient with severe systemic disease
what factors can increase the ASA sedation category by one?
patients who are current smokers, social alcohol drinkers, obesity (30 < BMI < 40), now have an ASA PS of 2.
what do we need to ask in social history of the patient:
- current work situation (can they take a day off?
- do they have a caring responsibility
- is it possible for them to find a suitable escort?
after doing all the presentation assessments, what do we need to decide?
- Whether sedation is indicated (if they have several caries roots that you need surgical extraction, GA may be more appropriate)
- What medical or other problems
have to be overcome and how (e.g. hypotension) - What treatment to be performed at
which visit – often dictated by pain
what do we advise the patient in the pre-sedation appointment?
- Effects of sedation (relaxed, spaced out, not asleep)
- Sedation is conscious and GA is put to sleep
- Duration and effect (need 24 hours to recover, no social media and internet shopping)
- Technique and equipment (IV sedation cannula is involved but topical anaesthetic can be used)
- Need for an escort/transport (private car or taxi not public transport)
- Feeding and medication (not to drink alcohol for 24hrs post-up, carry out routine meds, patient should have a light meal before such as toast or a sandwich), some places ask people to fast so you need to know where to refer your patient
after pre sedation assessment, medical history taking and advice about sedation technique, you need to let the patient decide. what else can you do to let them decide to have/ not have the treatment?
- Let them ask any question they have
- Meet the staff
- See the sedation room
- See the equipment if they wish
- Sign the content form
when should the consent form be signed?
in pre-assessment appointment as on the day of sedation, they are anxious and their consent can be invalid.
after the appointment, what is given in a written form to the patient?
- pre-operative instruction (advise that they familiarise the escort of it too)
- Post-operative instructions (given to escort)
- booked a post-op appointment
what is checked on the day of sedation?
- Check for health changes, eg colds, new medication
- Check escort and transport
- Check other preparations, eg no alcohol 24 hours before the appointment or recreational drugs
- Check consent is still valid
