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BDS Finals > Sedation > Flashcards

Sedation Flashcards

1
Q

Where are ventilation and perfusion greater in the lung

A

At the base

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2
Q

In what position are differences in ventilation and perfusion less marked

A

Prone position

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3
Q

Where is nitrous oxide carried through the body

A

Simple solution in blood

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4
Q

Common special care patient group for sedation (3)

A
  1. Involuntary movements
  2. Learning difficulties
    These can both be congenital or acquired
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5
Q

Consent for sedation

A

Must be written consent

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6
Q

Form allowing sedation treatment for AWI - how long does it last

A

36 months

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7
Q

Conscious Sedation Techniques (4)

A
  1. Inhalation
  2. Intravenous
  3. Oral
  4. Transmucosal
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8
Q

Inhalation Sedation Advantages (3)

A
  1. Anxiety relief
  2. Rapid recovery
  3. Flexible duration
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9
Q

Inhalation Sedation Disadvantages (3)

A
  1. Keeping nasal hood in place
  2. Less muscle relaxation
  3. Coordination of nasal breathing when mouth open
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10
Q

Intravenous Sedation Drug used (2)

A

Midazolam
Propofol

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11
Q

Intravenous Sedation Advantages (3)

A
  1. Good sedation
  2. Less cooperation needed
  3. Muscle relaxation
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12
Q

Intravenous Sedation Disadvantages (5)

A
  1. Baseline readings
  2. IV cannulation
  3. Assessing sedation level
  4. Behaviour during recovery
  5. Efficacy swallowing
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13
Q

Intravenous Sedation - Safety (5)

A
  1. Swallowing
  2. Airway
  3. Liver
  4. Medication interactions
  5. ASA
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14
Q

Oral/Transmucosal Sedation Advantages (4)

A
  1. Avoids cannulation
  2. Can make induction more pleasant
  3. Better cooperation
  4. Better future behaviour
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15
Q

Oral/Transmucosal Sedation Disadvantages (6)

A
  1. Baseline readings
  2. Bitter taste/stinging
  3. Lag time
  4. Untreatable
  5. Difficulty monitoring level of sedation
  6. Behaviour in recovery
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16
Q

Complications of cannulation (5)

A
  1. Venospasm
  2. Extravascular injection
  3. Intraarterial injection
  4. Haematoma
  5. Fainting
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17
Q

What is venospasm

A

Vein collapses at attempted venepuncture

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18
Q

What makes venospasm worse

A

Repeated attempts

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19
Q

Preventing venospasm (2)

A
  1. Efficient, quick technique
  2. Gloves in winter
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20
Q

Extravascular injection

A

Drug placed into interstitial space

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21
Q

Extravascular injection diagnosis - sedation (2)

A

Pain
Swelling

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22
Q

Extravascular injection problems - sedation (2)

A

Delayed absorption
If more drug given, double dosage

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23
Q

Extravascular injection prevention (2)

A

Good cannulation
Saline flush

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24
Q

Extravascular injection treatment (3)

A

Remove cannula
Apply pressure
Reassure

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25
Q

Intraarterial injection diagnosis - sedation (5)

A
  1. Pain on venepuncture
  2. Red blood in cannula
  3. Difficult to prevent leaks
  4. Pain radiating distally from site of cannulation
  5. Loss of colour of warmth to limb/weakening pulse
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26
Q

Intraarterial injection prevention (2)

A

Avoid anatomically prone sites - ACF medial to biceps tendon
Palpate before attack

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27
Q

Intraarterial injection management (5)

A
  1. Do not give drug
  2. Monitor for loss of pulse, cold, discolouration
  3. Leave cannula in situ for 5 minutes post drug
  4. No problems - remove
  5. Symptomatic - leave and refer to hospital (procaine 1%)
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28
Q

Haematoma

A

Extravasation of blood into soft tissues

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29
Q

Cause of haematoma (3)

A
  1. Damage to vein walls
  2. At venepuncture - poor technique
  3. At removal - failure to apply pressure
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30
Q

Haematoma Prevention - sedation (3)

A

Good cannulation technique
Pressure post operatively
Care with elderly

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31
Q

Haematoma treatment - sedation (5)

A
  1. Time
  2. Rest
  3. Reassurance
  4. If severe - initial ice pack
  5. Consider heparin containing gel
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32
Q

Fainting management - sedation (4)

A
  1. Patients should have eaten
  2. Topical skin anaesthesia
  3. RA first
  4. Position patient - if they don’t come around with feet up its not a faint
33
Q

Intravenous Sedation - Drug administration complications (5)

A
  1. Hyper responders
  2. Hypo responders
  3. Paradoxical reactions
  4. Oversedation
  5. Allergic reactions
34
Q

Allergic reaction to sedation drug

A

Don’t give the reverse - Also a pam and can make reaction worse

35
Q

Hyper responders - sedation (3)

A
  1. Deep sedation with minimal dose
  2. 1mg increments
  3. Slow titration in elderly
36
Q

Hypo responders - sedation (3)

A
  1. Little sedative effect in large doses
  2. Check cannula in vein
  3. May be due to tolerance
37
Q

Threshold to abandon sedation

A

10mg

38
Q

Paradoxical reactions - sedation (4)

A
  1. React extremely to stimuli
  2. Check for failure of LA
  3. Can do the opposite of sedate
  4. Find other management technique
39
Q

Oversedation issues (4)

A
  1. Loss of responsiveness
  2. Respiratory depression
  3. Loss of ability to maintain airway
  4. Respiratory arrest
40
Q

Oversedation management (4)

A
  1. Try to rouse patient
  2. ABC
  3. If no response to stimulation and support - reverse with flumazenil
  4. Watch for 1-4 hours
41
Q

Respiratory depression - management (4)

A
  1. Check oximeter
  2. Ask patient to take deep breaths
  3. Nasal oxygen cannulae 2L/min
  4. Reverse with flumazenil
42
Q

Signs and Symptoms of nitrous oxide overdose (6)

A
  1. Pt discomfort
  2. Lack of cooperation
  3. Mouth breathing
  4. Giggling
  5. Nausea/vomiting
  6. Loss of consciousness
43
Q

Nitrous oxide overdose treatment (3)

A
  1. Decrease nitrous oxide concentration by 5-10%
  2. Reassurance
  3. Don’t remove nosepiece
44
Q

What can happen if you remove the nosepiece too early in sedation?

A

Diffusion hypoxia

45
Q

Definition of sedation (3)

A
  1. Drugs produce a state of depression of the CNS
  2. Verbal contact with the patient is maintained
  3. Margin of safety is wide enough to render unintended loss of consciousness unlikely
46
Q

Deep sedation

A

Verbal contact with patient not maintained
Regarded as general anaesthesia

47
Q

Medical contraindications for sedation (5)

A
  1. Severe/uncontrolled systemic disease
  2. Severe mental/physical disability
  3. Severe psychiatric problems
  4. Narcolepsy
  5. Hyperthyroidism
48
Q

Contraindications for intravenous sedation (5)

A
  1. Intracranial pathology
  2. COPD
  3. Myasthenia gravis
  4. Hepatic insufficiency
  5. Pregnancy and lactation
49
Q

Contraindications for inhalation sedation (3)

A
  1. Blocked nasal airway
  2. COPD
  3. Pregnancy (dentist)
50
Q

Social contraindications for sedation (5)

A
  1. Unwilling
  2. Uncooperative
  3. Unaccompanied
  4. Children (for IV)
  5. Very old
51
Q

How old must children be to get IV sedation

A

> 12

52
Q

Dental contraindications for sedation (4)

A
  1. Procedure too difficult for LA alone
  2. Procedure too long
  3. Spreading infection
  4. Procedure too traumatic
53
Q

Advantages of sedation (3)

A
  1. Decrease stress for everyone
  2. Fewer medical incidents
  3. More productive appointments
54
Q

Disadvantages of sedation (3)

A
  1. Training required
  2. Equipment required
  3. Recovery time and after care
55
Q

ASA Class I

A

A normal healthy patient

56
Q

ASA Class II

A

A patient with mild systemic disease

57
Q

ASA Class III

A

A patient with severe systemic disease

58
Q

ASA Class IV

A

A patient with severe systemic disease that is a constant threat to life

59
Q

ASA Class V

A

A moribund patient who is not expected to survive without the operation

60
Q

ASA Class VI

A

A declared brain dead patient whose organs are being removed for donor purposes

61
Q

What should we be competent at on graduation in relation to sedation

A

Assessment of patients who may go on to have sedation and discussion with them about their options

62
Q

Locations for IV sedation (2)

A
  1. Antecubital fossa
  2. Dorsum of hand
63
Q

When should sedation assessment be carried out

A

On a separate visit to the sedation visit

64
Q

What does a sedation assessment entail (5)

A
  1. History
  2. Examination (vital signs)
  3. Tx plan
  4. Consent
  5. Informations for patient and escort
65
Q

SH sedation assessment (5)

A
  1. Nature of fear
  2. Phobia vs anxiety
  3. Anxiety questionnaire
  4. Responsibilities - children?
  5. Transport
66
Q

PDH sedation assessment (4)

A
  1. Referral source
  2. Previous sedation? Problems?
  3. Proposed procedure
  4. Symptoms - acute or chronic
67
Q

Drug effects on midazolam

A

Almost all drugs increase the sedative effect of midazolam

68
Q

If a patient doesn’t know what drugs they’re on at a sedation assessment what should be done

A

Seek confirmation

69
Q

What ASA classifications can be treated with sedation in primary care

A

I and II

70
Q

What ASA classification should be treated in secondary care

A

III

71
Q

What ASA classification MUST be treated in secondary care

A

IV

72
Q

What do almost all sedation drugs do to the airway

A

Respiratory depression

73
Q

Asthma questions for sedation assessment (3)

A
  1. What drugs and how often
  2. Have they been hospitalised
  3. Exacerbated by stress
74
Q

Predictable interactions between drugs (2)

A
  1. Antidepressants + BDZs
  2. Antihypertensives + BDZs
75
Q

Pharmacodynamic interactions definition

A

Interactions between drugs which have similar or antagonistic pharmacological effects

76
Q

Pharmacokinetic interactions definition

A

One drug alters the absorption, distribution, metabolism or excretion of another, thereby changing the amount of drug available to produce effects

77
Q

Which is more predictable, pharmacodynamic or pharmacokinetic interactions

A

Pharmacodynamic

78
Q

Vital signs checked at sedation assessment (4)

A
  1. HR
  2. BP
  3. Oxygen saturation
  4. BMI
79
Q

Ideal working time for sedation

A

45 minutes

BDS Finals (23 decks)

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