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FINALS!!! > Sedation > Flashcards

Sedation Flashcards

1
Q

What does ASA stand for

A

Amercian Society of Anaesteologist of medical status

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2
Q

ASA I and ASA II tx

A

done by trained sedation dentist

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3
Q

ASA III

A

done in a hospital setting

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4
Q

ASA I

A

normal healthy person
non smoker
minimium alcohol

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5
Q

ASA II

A

mild systemic disease - preg, well controlled asthma, epilepsy, diabetes
blood pressure - 140154/90-94

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6
Q

ASA III

A

severe systemic disease - type 1 diabetes, stable angina, COPD, 6months MI and CVA
Blood pressure = 160-199/95-114

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7
Q

ASA IV

A

severe systemic disease, constant threat to life
unstable angina
severe COPD
<6months MI and CVA
Blood pressure 200/115

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8
Q

ASA V

A

moribud, not expected to survive operation

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9
Q

ASA VI

A

brain dead, organs for dontation

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10
Q

Vital signs to monitor during sedation

A

blood pressure
heart rate
O2 levels - pulse oximeter
weight - weight/height2

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11
Q

Contraindications of sedation

A

severe uncontrolled systemic disease
severe physical or mental handicap
pyschaitric disorders
hypothyroidism
prep pts
COPD
spreading infection which could comrpomise airway

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12
Q

Indications for sedation

A

pt with poor co-operation
mild learning difficutlies
cerbral palsy
Parkinsons
phobias/gagging
neddle phobias

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13
Q

What drugs do sedation interact with

A

alcohol
opoids
erythomycin
recreational drugs
antidepressants
antihistamines
antipsychiotics

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14
Q

Complications of sedation

A

sexual fantasy
allergic reaction
over sedation
hyop repsonders
hyper responders
fainting
haematoma
intra-arterial injection
venospasm
extravascular injection

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15
Q

Indications of inhalation sedation

A

anxious
needle phobia
gaggers - nitrous oxide reduces gag reflex
medical conditions aggravated by stress
unaccompained but required sedation
liver problems

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16
Q

Contraindications of inhalation sedation

A

common cold
severe COPD
first trimester of pregnancy
fear of mask
tonsillar/ adenoid enlargement

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17
Q

Advantages of inhlation sedation

A

no amnesia
no injection
rapid onset and peak
quick revoery
few side effects

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18
Q

Disadvantages of inhaltion sedation

A

equipement and gas expensive
requires to breathe through nose
space for equipment
not potent
staff can become addicted to it

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19
Q

What colour os oxygen cylinder

A

black

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20
Q

what colour is NO2

A

blue

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21
Q

Equipment for inhalation sedation

A

gas cyclinders
pressure reducing valves
flow control meter
reservoir bag
gas delivery hoses
nasal hood
waste gaas scavenging system

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22
Q

Pre op insturctions before inhalation sedation

A

light meal before
meds as normal
children accompained by adult
adults accompained for 1st sedation appt
no alcohol
sensible clothing

23
Q

Signs of adequate inhaltion sedation

A

relaxed and comfortable
pt awake
reduced blink reflex
verbal contact maininted
decrease reaction to painful stimuli
decrease in spontaneous movement

24
Q

Oversedation signs

A

nasuea/vomiting
mouth closes repeatdely
decreased co-operation
uncontrollable laughter/tears
loss of consciuness
incoherent speech
sluggish response

25
Q

Sites for cannulation of iv sedation

A

dorsum of hand
antecubital fossa

26
Q

Vernil’s sign

A

drooping of eyelids

27
Q

Eve’s sign

A

touch nose with finger

28
Q

Midazolam

A

5mg/5ml (1mg/1ml)
pH 3.5 - allows to be soluble when injected
more potent and rapid
metabolised in liver and extra hepatic metabolism in bowel

29
Q

What can unsedate a pt if required

A

flumazenil - benzodiazepine antagonsit
200mcg then 100mcg every 60 secs

30
Q

4 main valves in the hearrt

A

tricuspud
pulpmnary
mitral
aortic

31
Q

Pulmonary circulation

A

oxygen depleted blood leaves the ringth ventricle reached the lung and replinshed with oxygen and back to left atrium

32
Q

Systemic circulation

A

sino atrial node sends eletrical signals through atria causing contraction pushing blood into ventricles
incrseased pressure pushes bi and tricuspic vavlves open
electircal activity reached avn and action poteitnals trasferred along purkinje system

33
Q

The cardiac cycle

A

atrial systole
ventricular systole
verntricular diastole

34
Q

Ventricular systole

A

isovolumetirc ventricular contraction - contraction but no change in volume, increase in pressure

35
Q

Ventricular diastole

A

isovolumetric relaxation - volume does not change and ventricles passively fill up

36
Q

What is starling’s law

A

related to end diastolic volume
higher it is the higher the stroke volume

37
Q

what is the afterload

A

the force the heart has on systole
the pressure needed to pump against arterial blood pressure and total pherpieral resistance

38
Q

What is dead space

A

air inhaled but does not reach the alveoli

39
Q

Anatomical dead space

A

air breathed in but stays in conducting zone (no active gas trasnfer)

40
Q

Alveolar dead space

A

due to perfusion of alveolus

41
Q

Haemogloblin

A

globular protein - 2 apha and 2 beta chains
4 haem groups within a porphyrin ring

42
Q

in sedation does nitrous oxide bind to haem

A

does not bind to haemogloblin and carried in blood

43
Q

How is carbon dioxide transported

A

by erythrocytes and blood plasma

44
Q

Hypocapnia

A

what should physiologically drive breathing
detected by central chemorecptors

45
Q

Hypoxia

A

how breathing is driven in COPD

46
Q

Hypoxic

A

decrease in oxygen reaching alveoli or decrased amount of oxygen diffusion into blood

47
Q

Anaemaia hypoxia

A

decrease in oxygen in blood due to low haem

48
Q

Stagnany (ischamic) hypoxia

A

low blood flow decreasing oxygen

49
Q

cytotoix hypoxia

A

low utilisation of oxygen by cells themselves

50
Q

Cyanosis

A

> 5g of deoxygenated haem/ 1 litre of blood

51
Q

Central cyanosis

A

affects the whole body, decrase in oxygen to blood

52
Q

What is central cyanosis caused by

A

low atomospheric oxygen pressure
decrseased airflow in airways
decreased oxygen diffusion into blood
decreased pulmonary blood flow
shunting

53
Q

Peripheral cyanosis

A

decreased oxygen delivery to localised and peripheral body part
decreased blood flow to tissues (stagnant hypoxia)

FINALS!!! (20 decks)

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