S&A 5 - Clinical principles and practice of inhalation sedation Flashcards
What is the purpose of a scavenging unit in inhalation sedation?
Removes exhaled gases from the environment at 45L/min
What are the safety features of the equipment when giving inhalation sedation?
Impossible to put NO/ oxygen tank in wrong placement - different diameter pins
NO tank is blue and oxygen tank is white
If oxygen runs out NO stops
Oxygen flush button for medical emergency
Can not give any less than 30% oxygen
What is inhalation sedations description?
Semi-hypnotic technique of conscious sedation to alleviate anxiety for sufficient cooperation, which all vital reflexes are intact
What are contraindications of inhalation sedation?
Claustraphobic Severe anxiety Middle ear/ sinus infection Behavioural problems URTI - simple cold Pregnancy Patients on methotrexate (anti-folate), NO potentiates anti-folate effect
What are the risks if a pregnant woman has inhalation sedation?
In 1st trimester - spontaneous abortion/ developmental effects
In 3rd trimester - can induce labour
What are the advantages of inhalation sedation?
- Rapid onset: 2-3 mins for clinical signs
- Rapid peak action: 3-5 mins
- Depth of sedation easily regulated
- Duration of sedation flexible
- Rapid recovery: 3-5 mins on 100% o2
- Moderate analgesia
- No injection
What are the disadvantages of inhalation sedation?
Cost
Space
Degree of cooperation
What are pre-op instructions for inhalation sedation?
Light meal 2-4hours before
No driving for rest of day
Children no bike rides rest of day
Children supervised by adult rest of day
How is NO titrated in inhalation sedation?
10 10 10 5 5 5 until max 70% nitrogen reached
What are the signs of adequate sedation?
Patient awake and verbal contact Warm tingling feeling Lethargy Flushed Reduced pain awareness Vital signs and reflexes intact
What can cause failure of sedation technique?
Patient breathing through mouth
Inefficient seal
Machine failure
Extreme anxiety
How is oxygen titrated back in recovery?
It isn’t - give 100% oxygen
What is diffusion hypoxia?
Breath for 2 to 3 minutes = PREVENT DIFFUSION HYPOXIA
Diffusion hypoxia – pt breaths in too much o2 which is expelled straight back out by the higher concentrations of nitrogen resulting in pt getting light head
Remove nasal hood and sit pt up – check not dizzy
What are the signs and symptoms of over sedation?
Signs –> nausea/ headache
Symptoms –> vomiting/ LOC
How is over sedation managed?
Reduce NO by 5-10%
Reassure/monitor patient
Continue/postpone tx.
Encourage patient to keep oxygen mask off
