SCD key points Flashcards
problems in providing dental tx
communication anxiety moving target perception of reality prev experience
who is SCD for?
those with a disability or activity restriction that directly or indirectly affects their oral health
common pt groups for sedation
movement disorders - congenital/genetic - acquired learning difficulties - congenital - acquired
CS techniques
IH IV oral transmucosal - rectal, intranasal, sublingual
choice of sedation technique
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?
advantages of IV sedation
good sedation achieved (deeper than IHS)
less cooperation needed
muscle relaxation
- can stop involuntary movements
disadvantages of IV sedation
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
IV sedation safety
swallowing airway liver medication interactions ASS
oral/transmucosal sedation
can drink 20mg midazolam
want same level of sedation as IV
oral/transmucosal sedation advantages
avoid cannulation
can make induction more pleasant
better cooperation
better future behaviour
oral/transmucosal sedation disadvantages
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
intranasal
midazolam up nose, nasal mucosa
no FMP
7 mins for sedation
more reliable
cannula for oral and IN
need to place once sedated as a safety measure - in case you need to reverse it
pre-med
small dose of BZD e.g. diazepam taken one hour before appt
mild sedative to help them get to surgery and have tx
outcome of sedation
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
GA or sedation
safety - controlled airway with GA - difficult intubation cooperation waiting lists and access to services pain MH still a need for GA
tx planning
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
indications of anxiety
fidgeting quiet talkative avoidance admits anxiety closed body language irregular attendance prev bad experiences
options if pt can’t cope with LA alone
CS - IS, IV, oral
GA
info to include in IVS referral
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
signs of sedation
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
considerations before IV sedation - separate assessment visit
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
considerations before IV sedation - MH
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)
considerations before IV sedation - weight
incidence of other systemic contraindications is higher, compromised cardio-respiratory fct, compromised airway
BMI <40
sedation score 0
alert and calm
sedation score 1
drowsy
sedation score 2
light sedation - eye contact to voice
sedation score 3
mod sedation - movement to voice but no eye contact
sedation score 4
deep sedation - no response to voice but movement to physical stimulation
sedation score 5
completely unrousable, no response
equipment in recovery
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
