Sedation Flashcards
List indications for sedation (5)
Medical condition aggravated by stress from dental tx
- Ischaemic heart disease
- High BP
- Asthma
- Epilepsy
Dental anxiety/phobia/gag
Medical conditions that affect cooperation - MS/cerebral palsy/parkinsons
Mild learning difficulties
Difficult dental procedures
List contraindications for sedation
Severe/uncontrolled systemic disease
Severe mental disability
Severe psychiatric problems
Narcolepsy
Hypothyroidism
IV Contraindications
Intracranial pathology
COPD
Muscle wasting
Pregnancy
IS Contraindications
Cold
COPD
Pregnancy
Advantages + disadvantages of IS
ADV
Rapid recovery
Flexible duration
DISADV
Keeping nasal hood in place
Less muscle relaxation
Cooperatoin
Advantages + disadvantages of IV
ADV
Less cooperation
Muscle relaxation
DISADV
Baseline readings
Cannula
Recovery
What are the ideal baseline reading values
HR - 60-100bpm
BP - 120/80
O2 - 95%
BMI - 35 is LIMIT for sedation
What ASA classes can we tx with sedation?
I and II
Tx if O2 saturation drops below ideal
2l/min O2
5l/min O2
Definition of sedation
Drugs used to produce a state of depression of CNS to allow tx
Verbal contact remains
What are the ASA Class definitions?
I - healthy, non smoker
II - mild systemic disease
III - severe systemic disease
IV - severe systemic disease constant threat to life
v - moribund
VI - brain dead
List IS equipment
Gas cylinder
Reservoir bag
Nasal hood
Colour coding cans
o2+nio2 pressure dials
Pressure reducing valves
One way expiratory valves
Describe IS in a patient friendly manner
This is when we use laughing gas (mix of o2+nio2) that you breathe in through your nose through a mask
Helps you feel nice and relaxed/comfortable for treatment
You are still awake/able to chat with us throughout the procedure
No needle in back of hand (still required in gum)
BEFORE:
Light meal
Bring any meds you take
Reschedule if cold
AFTER:
Tx roughly 90 mins, keep you 30 mins
Until effects worn off
Can drive home/work but avoid heavy machinery
Describe IV in a patient friendly manner
This is where we place a Neeld into the back of your hand to deliver some medication (Midazolam) to make you more relaxed.
Cannula is in throughout tx.
You are still awake/able to chat to us throughout the procedure.
You still require an injection in your gum.
BEFORE:
Escort
AM - no food
PM - light breakfast
Comfy clothes
No false nails/nail polish
AFTER:
No heavy machinery
Online shopping
Alcohol/driving 24hrs
No legal documents signed until next day
Why no nail polish?
Check skin + O2
How is Midazolam administered
Titrated dose 5mg/5ml
2mg bolus then 1mg increment every minute
Half life of Midazolam
90-150 mins
Where is Midazolam metabolised?
Liver
What changes does Midazolam create in body to cause sedation
CNS depression
Muscle relaxation
Decreased bp
Increased HR
How do we reverse effects of IV?
Flumazetil 200mg –> 100mg every min until response
Half life of Flumazetil
50 mins
Risk of Flumazetil use
Resedation
Max NiO for IS
70%
Min O2 for IS
30%
Continued checks throughout IV
Vitals (BP, HR, O2 saturation)
Skin
Capillary refill
RR
Sedation clinic discharge criteria
Orientated in time, place + person
Vitals stable
HAPOIG
Emergency contact given
List some complications of IV in regards to drug administration
Hyper-responders
Hypo-responders
Oversedation
Allergic reactions
List some complications of IV in regards to cannulation
Venospasm
Extravascular injection
Intra-arterial injectoin
Haematoma
Fainting
