Procedural sedation for pediatric dental patients (chapter 13) Flashcards
What is the most serious adverse outcome of pediatric sedation?
Respiratory compromise and associated consequences
T/F children have less surface for gas exchange in lungs?
T. Children have 20 million alveoli and adults have 300 million
T/F Children have small functional reserve lung capacity
True in comparison to adults
T/F children have relativly larger post-expiration volume
True
How does pediatric airway differ from adult airways?
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
When selecting patients for sedation what to look for?
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
What to look for in birth history for sedation patients?
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
Medical history for sedation patients?
allergies/asthmas/croup current meds diseases Malignant Hypertermia risk Sleep apnea-upper airway obstruction Previous sedations/GA/Hospitalizations Family history of disease
Physical assessment for sedation?
Airway-brodsky, mallimpati Mouth breather C-spine precautions- down syndrome and Arnold chiari malformations Midfacial hypoplasia Risk assessment- ASA III Obesity
Sedation dietary restrictions NPO?
2 hours clear liquids 4 hours breast milk 6 hours infant formula 6 hours non-human milk 6 hours light meal
How should medications be taken with NPO status?
Following NPO status. Bladder empty before giving meds.
Reason to cancel sedation appointment?
Non-NPO Fever/cough Active or recent upper respiratory infection Recent head trauma Recent change in note in medical history requiring consult
Should the MRD of local anesthetic be reduced when using moderate sedation to GA?
Yes, to reduce the CNS depression with both medication being used
What is the fatal TRIO?
Hypovolemia- verify patients not over NPO Hypoxia- recognize respiratory obstruction/distress Hypercapnia- may exist if hypoxia is present. May lead to cardiac arrhythmias
What muscles to inject IM?
Vastus lateralis Gluteus muscles
Where to inject submucosal for sedation?
Between 1st and 2nd primary maxillary molars
Chloral Hydrate drug
Sedative/hypnotic
CNS depressant 10-50mg/kg orally to 1gram max
No reversal agent
Diazepam
Valium
Benzodiazepine
0.25-.30mg/kg orally
flumazenil reversal 0.01mg/kg repeat up to total 1mg
Midazolam
Versed
benzodiazepine
0.5-0.75mg/kg to 15mg total
3-4x potency of diazepam
Hydroxyzine
Antiemetic/antihistaminic
dry mouth
0.5-1.0mg/kg orally
Used in combination w/chloral hydrate, meperidine or midazolam
Meperidine
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
What score to used for patient discharge after sedation?
Alternative Aldrete discharge criteria
Should you sedate if have Upper respiratory tract infection within 2 weeks of sedation?
No, reschedule
Respiratory distress signs
non-diaphram breathing
- nasal flarring
- platysma flaring
- grunting
- rocking horse/see-saw respiratory
- intercoastal muscle
Suggested management of airway obstruction AAPD guidelines
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
