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FINALS > Sedation > Flashcards

Sedation Flashcards

1
Q

what is the medicine administered in IV sedation

A

midazolam

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2
Q

what is the medicine administered in inhalation sedation

A

nitrous oxide

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3
Q

what is the definition of sedation

A

technique in which the use of a drug produces a state of depression in the CNS

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4
Q

name three complications of cannulation

A

venospasm
extravascular injection
haematoma
fainting

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5
Q

what is venospasm and what is it associated with

A

veins collapsing at attempted venepuncture
caused by poorly visible veins

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6
Q

what is extravascular injection and what problems can this cause

A

active drug is put into interstitial space and not a vein
causes delayed absorption of drug

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7
Q

what is a haematoma

A

extravasation of blood into soft tissue due to damage of vein walls

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8
Q

name five complications of drug administration

A

hyperresponders
hyporesponders
paradoxical reactions
oversedation
allergic reactions

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9
Q

what is the average dose of midazolam given

A

5-6mg

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10
Q

why may patients be hypo-responders to sedation

A

cross tolerance from taking recreational drugs
idiopathic

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11
Q

what is the maximum threshold of midazolam you should give before calling it a day

A

10mg in general practice
15mg in hospital setting

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12
Q

side effects of midazolam are increased in patients on what

A

opioids

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13
Q

what are paradoxical reactions

A

patients don’t sedate - they may appear hyper

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14
Q

name three effects that occur with oversedation

A

loss of responsiveness
respiratory depression
loss of ability to maintain airway

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15
Q

what is the reversal drug for midazolam

A

flumazenil 200mg

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16
Q

when an allergic reaction to midazolam occurs what should you do

A

do NOT give flumazenil (same family of drug)

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17
Q

what is the elimination half life of midazolam

A

1-2 hours - so the drug can be in the system for 12 hours
must have someone chaperone them

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18
Q

signs of nitrous oxide overdose

A

patient discomfort
giggling
nausea
loss of consciousness

19
Q

what is the treatment for nitrous oxide overdose

A

decrease nitrous oxide concentration by 10-15%
do not remove nosepiece in case of diffusion hypoxia

20
Q

what would determine the type of sedation you would use on a patient

A

patient cooperation
degree of anxiety
dentistry required
facilities available

21
Q

give two advantages and two disadvantages of inhalation sedation

A

rapid recover
flexible duration

keeping nasal hood in place
coordination of breathing nasally while mouth is open

22
Q

give two advantages and two disadvantages of intravenous sedation

A

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

23
Q

what classification is used to assess patients who may require sedation

A

ASA

24
Q

name three contra-indications to IV sedation

A

COPD
hepatic insufficiency
pregnancy and lactation

25
Q

name three contra-indications of inhalation sedation

A

pregnancy
blocked nasal airway
COPD

26
Q

how do benzodiazepines work

A

act on receptors in CNS to enhance effect of GABA

27
Q

what allows benzodiazepines to attach to receptors in the CNS

A

benzine ring

28
Q

name three effects that benzodiazepines have

A

CNS depression and muscle relaxation
decreased BP (due to muscle relaxing)
increased heart rate (compensate for fall in BP)

29
Q

what is the preparation for midazolam for sedation and where is it metabolised

A

5mg/ kg
metabolised in liver

30
Q

what are the 4 benefits of midazolam over diazepam

A

painless
quicker onset
quicker recovery
more reliable

31
Q

what are the two cannulation sites for IV sedation

A

dorsum of hand
antecubital fossa

32
Q

how often should NIBP measurements be taken during IV sedation

A

every 5-10 minutes

33
Q

how is a respiratory depression managed in IV sedation

A

talk/ shake patient
head tilt/ chin lift
2ml/ min nasal canulae of O2
flumazenil

34
Q

how long after last increment of IV sedation is given does the patient have to stay

A

60 mins

35
Q

what two types of drug have pharmacodynamic interactions with benzodiazepines

A

antidepressants
antihypertensives

36
Q

what vital signs are taken at a sedation assessment

A

heart rate
BP
oxygen saturation
weight
heught

37
Q

what is the maximum BMI score accepted for IV sedation

A

35

38
Q

what volume does the reservoir bag for inhalation sedation hold

A

2-3 litres

39
Q

what colour is the pipe for nitrous oxide delivery in inhalation sedation

A

blue

40
Q

what colour is the pipe for oxygen delivery in inhalation sedation

A

black

41
Q

name four pre-op instructions for inhalation sedation

A

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

42
Q

what should the flow for inhalation sedation be set to

A

5-6 litres per minute

43
Q

how is recovery achieved after inhalation sedation

A

gradually increase O2 by 10% per minute until 100% reached and administer for 2-3 minutes

44
Q
A

FINALS (25 decks)

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