Sedation Flashcards
what is the medicine administered in IV sedation
midazolam
what is the medicine administered in inhalation sedation
nitrous oxide
what is the definition of sedation
technique in which the use of a drug produces a state of depression in the CNS
name three complications of cannulation
venospasm
extravascular injection
haematoma
fainting
what is venospasm and what is it associated with
veins collapsing at attempted venepuncture
caused by poorly visible veins
what is extravascular injection and what problems can this cause
active drug is put into interstitial space and not a vein
causes delayed absorption of drug
what is a haematoma
extravasation of blood into soft tissue due to damage of vein walls
name five complications of drug administration
hyperresponders
hyporesponders
paradoxical reactions
oversedation
allergic reactions
what is the average dose of midazolam given
5-6mg
why may patients be hypo-responders to sedation
cross tolerance from taking recreational drugs
idiopathic
what is the maximum threshold of midazolam you should give before calling it a day
10mg in general practice
15mg in hospital setting
side effects of midazolam are increased in patients on what
opioids
what are paradoxical reactions
patients don’t sedate - they may appear hyper
name three effects that occur with oversedation
loss of responsiveness
respiratory depression
loss of ability to maintain airway
what is the reversal drug for midazolam
flumazenil 200mg
when an allergic reaction to midazolam occurs what should you do
do NOT give flumazenil (same family of drug)
what is the elimination half life of midazolam
1-2 hours - so the drug can be in the system for 12 hours
must have someone chaperone them
signs of nitrous oxide overdose
patient discomfort
giggling
nausea
loss of consciousness
what is the treatment for nitrous oxide overdose
decrease nitrous oxide concentration by 10-15%
do not remove nosepiece in case of diffusion hypoxia
what would determine the type of sedation you would use on a patient
patient cooperation
degree of anxiety
dentistry required
facilities available
give two advantages and two disadvantages of inhalation sedation
rapid recover
flexible duration
keeping nasal hood in place
coordination of breathing nasally while mouth is open
give two advantages and two disadvantages of intravenous sedation
good sedation achieved
less cooperation required
IV cannulation required (still a needle)
ability to swallow - if patient cannot swallow they cannot be sedated with IV
what classification is used to assess patients who may require sedation
ASA
name three contra-indications to IV sedation
COPD
hepatic insufficiency
pregnancy and lactation
name three contra-indications of inhalation sedation
pregnancy
blocked nasal airway
COPD
how do benzodiazepines work
act on receptors in CNS to enhance effect of GABA
what allows benzodiazepines to attach to receptors in the CNS
benzine ring
name three effects that benzodiazepines have
CNS depression and muscle relaxation
decreased BP (due to muscle relaxing)
increased heart rate (compensate for fall in BP)
what is the preparation for midazolam for sedation and where is it metabolised
5mg/ kg
metabolised in liver
what are the 4 benefits of midazolam over diazepam
painless
quicker onset
quicker recovery
more reliable
what are the two cannulation sites for IV sedation
dorsum of hand
antecubital fossa
how often should NIBP measurements be taken during IV sedation
every 5-10 minutes
how is a respiratory depression managed in IV sedation
talk/ shake patient
head tilt/ chin lift
2ml/ min nasal canulae of O2
flumazenil
how long after last increment of IV sedation is given does the patient have to stay
60 mins
what two types of drug have pharmacodynamic interactions with benzodiazepines
antidepressants
antihypertensives
what vital signs are taken at a sedation assessment
heart rate
BP
oxygen saturation
weight
heught
what is the maximum BMI score accepted for IV sedation
35
what volume does the reservoir bag for inhalation sedation hold
2-3 litres
what colour is the pipe for nitrous oxide delivery in inhalation sedation
blue
what colour is the pipe for oxygen delivery in inhalation sedation
black
name four pre-op instructions for inhalation sedation
have light meal before appointment
children accompanied by competent adult
adults accompanied for first session
plan to remain in clinic for 30 minutes after treatment
what should the flow for inhalation sedation be set to
5-6 litres per minute
how is recovery achieved after inhalation sedation
gradually increase O2 by 10% per minute until 100% reached and administer for 2-3 minutes
