Procedural sedation for pediatric dental patients (chapter 13)

Question 1

What is the most serious adverse outcome of pediatric sedation?

Answer 1

Respiratory compromise and associated consequences

Question 2

T/F children have less surface for gas exchange in lungs?

Answer 2

T. Children have 20 million alveoli and adults have 300 million

Question 3

T/F Children have small functional reserve lung capacity

Answer 3

True in comparison to adults

Question 4

T/F children have relativly larger post-expiration volume

Answer 4

True

Question 5

How does pediatric airway differ from adult airways?

Answer 5

Increased airway resistance Glottis (vocal cord) are positioned more anteriorly and cephalad Narrowest portion of upper airway is at level of cricoid cartilage ( below vocal cords) Larger tongue/epiglottis mandible less developed significant lymphoid tissue obstructing: naslpharynx, orophyaynx, laryngopharynx

Question 6

When selecting patients for sedation what to look for?

Answer 6

traditional techniques unsuccessful ASA 1/2 patient below age of reason (pre or uncooperative) extent of treatment- determined by amount of local anesthetic needle phobic older children with poor experiences long distance traveled

Question 7

What to look for in birth history for sedation patients?

Answer 7

Birth history: Reduced surfactant-less surface area for gas exchange Hospital ventilator use increased gag reflex from altered neural reflex pathways greater risk of laryngospasm

Question 8

Medical history for sedation patients?

Answer 8

allergies/asthmas/croup current meds diseases Malignant Hypertermia risk Sleep apnea-upper airway obstruction Previous sedations/GA/Hospitalizations Family history of disease

Question 9

Physical assessment for sedation?

Answer 9

Airway-brodsky, mallimpati Mouth breather C-spine precautions- down syndrome and Arnold chiari malformations Midfacial hypoplasia Risk assessment- ASA III Obesity

Question 10

Sedation dietary restrictions NPO?

Answer 10

2 hours clear liquids 4 hours breast milk 6 hours infant formula 6 hours non-human milk 6 hours light meal

Question 11

How should medications be taken with NPO status?

Answer 11

Following NPO status. Bladder empty before giving meds.

Question 12

Reason to cancel sedation appointment?

Answer 12

Non-NPO Fever/cough Active or recent upper respiratory infection Recent head trauma Recent change in note in medical history requiring consult

Question 13

Should the MRD of local anesthetic be reduced when using moderate sedation to GA?

Answer 13

Yes, to reduce the CNS depression with both medication being used

Question 14

What is the fatal TRIO?

Answer 14

Hypovolemia- verify patients not over NPO Hypoxia- recognize respiratory obstruction/distress Hypercapnia- may exist if hypoxia is present. May lead to cardiac arrhythmias

Question 15

What muscles to inject IM?

Answer 15

Vastus lateralis Gluteus muscles

Question 16

Where to inject submucosal for sedation?

Answer 16

Between 1st and 2nd primary maxillary molars

Question 17

Chloral Hydrate drug

Answer 17

Sedative/hypnotic

CNS depressant 10-50mg/kg orally to 1gram max

No reversal agent

Question 18

Diazepam

Answer 18

Valium

Benzodiazepine

0.25-.30mg/kg orally

flumazenil reversal 0.01mg/kg repeat up to total 1mg

Question 19

Midazolam

Answer 19

Versed

benzodiazepine

0.5-0.75mg/kg to 15mg total

3-4x potency of diazepam

Question 20

Hydroxyzine

Answer 20

Antiemetic/antihistaminic

dry mouth

0.5-1.0mg/kg orally

Used in combination w/chloral hydrate, meperidine or midazolam

Question 21

Meperidine

Answer 21

Demerol

1-2mg/kg

narcotic

nalozone reversal 0.1mg/kg 2.0mg max

Do not used in patients with history of asthma-shift tree from prostaglandins to leukotrines which are bronchial irritants

Question 22

What score to used for patient discharge after sedation?

Answer 22

Alternative Aldrete discharge criteria

Question 23

Should you sedate if have Upper respiratory tract infection within 2 weeks of sedation?

Answer 23

No, reschedule

Question 24

Respiratory distress signs

Answer 24

non-diaphram breathing

• nasal flarring
• platysma flaring
• grunting
• rocking horse/see-saw respiratory
• intercoastal muscle

Question 25

Suggested management of airway obstruction AAPD guidelines

Answer 25

1) reposition airway
2) perform jaw thrust
3) insert oral airway
4) call for help
5) insert nasal trumpet
6) insert supraglottic device
7) tracheal intubation
8) surgical airway