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sedation > SCD key points > Flashcards

SCD key points Flashcards

1
Q

problems in providing dental tx

A 
communication
anxiety
moving target
perception of reality
prev experience
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2
Q

who is SCD for?

A

those with a disability or activity restriction that directly or indirectly affects their oral health

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3
Q

common pt groups for sedation

A 
movement disorders
 - congenital/genetic
 - acquired
learning difficulties
 - congenital
 - acquired
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4
Q

CS techniques

A 
IH
IV
oral
transmucosal
 - rectal, intranasal, sublingual
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5
Q

choice of sedation technique

A 
pt cooperation
 - if 0 probably GA
degree of anxiety
dentistry required
 - if v traumatic get IV as amnesia
skills of dental team
pt prev experience
 - if they have had a successful type of sedation before don't change it
facilities available
anaesthetist required?
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6
Q

advantages of IV sedation

A

good sedation achieved (deeper than IHS)
less cooperation needed
muscle relaxation
- can stop involuntary movements

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7
Q

disadvantages of IV sedation

A

baseline readings (need cooperation)
cannulation
assessing sedation level
- hard if pt non-verbal - thumbs up/blink
behaviour during recovery - can be upset
efficacy swallowing
- if pt has poor swallowing don’t give them a drug that makes it worse - check their swallowing - diet etc

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8
Q

IV sedation safety

A 
swallowing
airway
liver
medication interactions
ASS
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9
Q

oral/transmucosal sedation

A

can drink 20mg midazolam

want same level of sedation as IV

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10
Q

oral/transmucosal sedation advantages

A

avoid cannulation
can make induction more pleasant
better cooperation
better future behaviour

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11
Q

oral/transmucosal sedation disadvantages

A 
baseline readings
bitter taste/stinging
lag time 30mins
 - takes time to be absorbed
untitrateable - given as bolus dose
difficulty in monitoring level of sedation - unpredictable
behaviour in recovery
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12
Q

intranasal

A

midazolam up nose, nasal mucosa
no FMP
7 mins for sedation
more reliable

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13
Q

cannula for oral and IN

A

need to place once sedated as a safety measure - in case you need to reverse it

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14
Q

pre-med

A

small dose of BZD e.g. diazepam taken one hour before appt

mild sedative to help them get to surgery and have tx

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15
Q

outcome of sedation

A 
all needed tx carried out
some tx can be carried out
 - rest needs GA
exam, scale and polish
 - refer to GA for tx
other txs
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16
Q

GA or sedation

A 
safety
 - controlled airway with GA
 - difficult intubation
cooperation
waiting lists and access to services
pain
MH
still a need for GA
17
Q

tx planning

A

pre-sedation exam may not be possible
ability to cope
complicated tx? - maintenance - can they do OH?/carers interested/capable
tx pt not carer
use sedation because of clinical need
can medics do other things too e.g. take bloods

18
Q

indications of anxiety

A 
fidgeting
quiet
talkative
avoidance
admits anxiety
closed body language
irregular attendance
prev bad experiences
19
Q

options if pt can’t cope with LA alone

A

CS - IS, IV, oral

GA

20
Q

info to include in IVS referral

A

pt name, age, CHI, address, contact number
details of referrer inc name, practice address and contact number
reason for referral
which options you have discussed with pt
justification for intended tx
comprehensive MH
DH
SH
any prev sedation experience and where this was carried out

21
Q

signs of sedation

A 
anxiolysis
reduced attention
anterograde amnesia
 - once sedated pt isn't really forming new memories
heavy eyelids
reduced resp rate
delayed response
muscle relaxation (reduced trismus)
drowsiness/sleepiness
difficulty touching tip of nose with fingwr
changes in speech
22
Q

considerations before IV sedation - separate assessment visit

A 
MH
recreational drugs
smoking
alcohol
weight BMI
consent
escort (12hrs)
no responsibilities e.g. children, pets
no driving for 24hrs
check over pre-op assessment
baseline obs
 -bp, pulse, O2 sats, resp rate
23
Q

considerations before IV sedation - MH

A

cardiac and respiratory
- resp depression with midazolam due to CNS
depression and muscle relaxation
hepatic/renal
- affects metabolism and excretion of midazolam,
unpredictable and risk of oversedation or prolonged
recovery
meds and allergies
- other CNS depressants (opiates, antidepressants)
- muscle relaxants (baclofen, amitriptyline)
- antihistamines
- antihypertensives
- ABs (erythromycin)

24
Q

considerations before IV sedation - weight

A

incidence of other systemic contraindications is higher, compromised cardio-respiratory fct, compromised airway
BMI <40

25
Q

sedation score 0

A

alert and calm

26
Q

sedation score 1

A

drowsy

27
Q

sedation score 2

A

light sedation - eye contact to voice

28
Q

sedation score 3

A

mod sedation - movement to voice but no eye contact

29
Q

sedation score 4

A

deep sedation - no response to voice but movement to physical stimulation

30
Q

sedation score 5

A

completely unrousable, no response

31
Q

equipment in recovery

A

high backed chair
chair/trolley able to go into supine position
available O2 and suction
bp machine and pulse oximeter
seat for escort
cotton wool rolls and spot plasters for removal of cannula
POI sheet

sedation (6 decks)

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