Sedation Flashcards
What is iatrodesation
A technique of communication between dentist and patient that creates a bond of trust and confidence
What are nondrug psychosedative techniques?
Hypnosis, acupuncture, audioanalgesia
What are routes of drug administration
Oral, topical, subcutaneous, inhalation
Rectal, intranasal, sublingual, transdermal, intramuscular, intravenous, intraarterial, intrathecal, intramedullary, intraperitoneal
What is minimal sedation/anxiolysis
-Minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command
-Ventilatory and cardiovascular functions are unaffected
What is moderate sedation
-Drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation
-No interventions required to maintain a patent airway
-Cardiovascular function is usually maintained
What is deep sedation
-Drug induced depression of consciousness during which patients cannot easily be aroused, but respond purposefully following repeated or painful stimulation
-The ability to independently maintain ventilatory function may be impaired
-Cardiovascular function is usually maintained
What is general anesthesia
-Drug induced loss of consciousness during which patients are not arousable, even by painful stimulation
-Ability to independently maintain ventilatory function is often impaired
-Cardiovascular function may be impaired
What is legally allowed as a dentist
Most states allow minimal sedation without any additional training
Board of dentistry in your state regulates sedation
Higher = CODA accredited post-dr training required. Some boards allow board-approved CE. ACLS or PALS usually required too
In KY what are the laws on sedation
Liscensed dentist may administer minimal enteral sedation without a permit
N2O can be combined with oral medication but “level of sedation shall be maintained at level of minimal sedation”
Higher sedation = CODA accredited post doctoral training is reuiqred
What sedation levels require monitoring
Any level beyond minimal
What does monitoring include
BP (every 5 minutes in parenteral moderate or greater)
ECG
Pulse oximetry
Temperature
What are the most effective and most popular drugs for anxiety management in dentistry
Oral benzodiazepines (CNS depressants = avoid motor vehicles, alcohol, opioids and barbiturates)
- good for mild-moderate pre-tx anxiety
- dosage based on drug, age, medical hx and level of anxiety
- provides minimal to moderate sedation
- must have escort
- Diazepam and Triazolam are most common
- cannot be truly titrated
What are the most well known (and most popular) IV sedative drugs in dentistry and medicine
Benzodiazepines:
Diazepam (Valium)
Midazolam (Versed) —- most popular
What are IV sedation drugs usually used with
In combination with other drugs for moderate or deep sedation
What are effects of IV sedation drugs
Little significant effect on CV or respiratory system when recommended doses are used via recommended techniques (titration)
