Restorative - Outcome 4 Flashcards
Intravenous (IV) Sedation
Anti-anxiety drugs IV are administered throughout the procedure at a slower pace, providing a deeper stage I analgesia.
Conscious IV sedation is frequently used by an oral surgeon during such procedures as the extraction of third molars, especially in difficult cases, such as when teeth are impacted and surgical removal of bone is necessary.
Local anesthesia is administered once the patient’s condition is stable with IV conscious sedation. This also helps ease postoperative pain until oral analgesics can be taken.
Patient Assessment Before IV Sedation:
A health history is taken, a physical examination performed and signed consent obtained
Baseline vital signs are taken and recorded
Oximetry and electrocardiography are performed and recorded
The patient’s weight is taken and recorded for the determination of dosage
IV Sedation Monitoring
Patient monitoring:
Physiologic measurements are recorded every 15 minutes
Level of consciousness
Respiratory function
Oximetry
Blood pressure
Heart rate
Cardiac rhythm
In addition to the operating dentist and the assistant, a registered nurse is usually present to properly administer the medications through the IV line and monitor the patient’s vital signs throughout surgery.
Although vital signs may only be formally recorded every 15 minutes, some dental offices choose to record them more frequently.
General Anesthesia
A controlled state of unconsciousness with a loss of protective reflexes—including the ability to maintain an airway independently and to respond appropriately to physical stimulation or verbal command—that produces stage III general anesthesia.
General anesthesia is indicated for severely medically compromised or mentally disabled individuals who cannot be adequately treated in a regular dental setting.
Because of the loss of protective reflexes with general anesthesia, the patient is intubated, usually through the nose (to keep the oral cavity clear), for delivery of oxygen and anesthetic gases; other medications are administered simultaneously by way of an IV line.
Pharmacological Make up - Sedation
Combination of gases
N2O/O2
Halothane or enflurane mixture
IV agents such as thiopental sodium and methohexital sodium
A thorough preoperative examination, including a physical examination, blood tests, and sometimes cardiac tests, is performed and reviewed as part of the medical history before the administration of general anesthesia.
Both inhalation gases and IV agents are calculated and chosen according to the patient’s health history, the anticipated length and type of surgery, and the anesthesiologist’s preferences.
Four Stages of Anesthesia
Stage I: Analgesia
Stage II: Excitement:
Stage III: General anesthesia:
Stage IV: Respiratory failure or cardiac arrest
Stages of Anesthesia - Stage I: Analgesia
At this stage, the patient is relaxed and fully conscious
The patient is able to keep his or her mouth open without assistance and is capable of following directions
The patient has a sense of euphoria and a reduction in pain
Vital signs are normal
The patient can move into different levels of analgesia
Stages of Anesthesia - Stage II: Excitement
At this stage, the patient is less aware of his or her immediate surroundings
The patient starts to become unconscious
The patient may become excited and unmanageable
Nausea and vomiting may occur
This is an undesirable stage
Stages of Anesthesia - Stage III: General anesthesia
Although the patient is thought to feel no pain, local anesthesia is usually administered to control bleeding throughout the procedure, as well as at or near the end to help with postoperative pain control.
A throat pack is always placed so that the airway and esophagus are protected from instruments, irrigating solutions and blood, materials, and free tissue debris, as well as to keep the stomach from filling with liquid that may cause postoperative nausea and vomiting.
This stage of anesthesia begins when the patient becomes calm after stage II
The patient feels no pain or sensation
The patient will become unconscious
This stage of anesthesia can be met only under the guidance of an anesthesiologist in a controlled environment such as a hospital or at an outpatient surgical center with all the necessary equipment to manage an emergency.
Stages of Anesthesia - Stage IV: Respiratory failure or cardiac arrest
At this stage, the lungs and heart slow down or stop functioning If this stage is not reversed quickly, the patient will die.
Because of the risk, it is very important that patients be well informed, that they thoroughly discuss the dental office’s consent form, and that all other anesthetic options have been exhausted or found to be inappropriate before general anesthesia is chosen.
Patient Recovery - after unconscious sedation
Once the procedure is completed, the patient is monitored closely until normal reflexes return
The patient should not be left alone while regaining consciousness
Documentation of Anesthesia and Pain control
-Along with a detailed account of the actual surgical procedure, the name, concentration, and amount of anesthesia used; the time at which it was administered; and the route of administration (e.g., local infiltration, IV, inhalation) should be noted.
-For local anesthesia, remember to note whether it contained a vasoconstrictor, and if so, the type and concentration.
-Any post-operative instructions should also be documented.
-Always document the following measures and observations:
-Review of the patient’s medical history
-Preoperative and postoperative vital signs
-Patient’s tidal volume if inhalation sedation is being used
-Times at which anesthesia began and ended
-Peak concentration administered
-Postoperative time (in minutes) required for patient recovery
-Adverse events and patient complaints
What are the 2 types of sedation used in dentistry?
There are two types of sedation used in dentistry.
- Conscious sedation
- Unconscious sedation
IV Sedation
Performed in a dental office setting or a surgical suite. *The process of starting, monitoring, and removing IV sedation can only be performed by an individual who is trained and certified in this area.
Benefits for the following patients and conditions:
Uncooperative children requiring extensive dental treatment.
Children are unable to sit through treatment.
Treatment can be completed in one visit.
A positive dental experience by limiting pain and discomfort.
Fear, anxiety, and phobias
Low pain threshold, and an inability to be numbed.
Extensive treatment
Reduces the amount of time required to complete treatment
Special needs patients (physically and mentally challenged)
Medically compromised patients
Cardiac issues are best treated under sedation to reduce the risk of cardiac arrest during treatment
Neurological issues are best addressed under sedation to minimize the risk of uncontrolled movements during treatment.
Conscious Sedation
Most patients will not remember the actual dental procedure, even though they are conscious.
The patient can still speak and respond to the requests of others.
All body functions remain normal, and the person is able to breathe on their own.
There is a state of very deep relaxation.
Local anesthetic should still be used.
