Sedation

Question 1

Define ‘conscious sedation’

Answer 1

• Technique involving the use of a DRUG(S) to induce CNS DEPRESSION, facilitating tx to be carried out
• VERBAL CONTACT is maintained throughout procedure
• Drug and technique used carry wide enough MARGIN OF SAFETY to render LOC unlikely
• Conscious
• Protective reflexes
• Responds to verbal commands

Question 2

When should sedation or GA NOT be carried out?

Answer 2

No proper EQUIPMENT and inadequate FACILITIES for RESUSCITATION readily available where operator and staff NOT TRAINED

Question 3

What are the alternatives to GA?

Answer 3

• LA
• Behavioural management
• Hypnosis/ relaxation
• Conscious sedation

Question 4

What drug is commonly used for inhalation sedation?

Answer 4

Nitrous oxide

Question 5

What is the recommended limit for NO titration with O2?

Answer 5

30%

i. e. 30% NO, 70% O2
- Titrated at 5% increments every 5mins

Question 6

What are the contraindications for inhalation sedation?

Answer 6

• Common cold
• Tonsillitis
• Nasal blockage
• Neuromuscular disease (e.g. MS)

Question 7

What are the safety features of inhalation sedation?

Answer 7

1. COLOURED tanks (oxygen black, nitrous oxide blue)
2. PIN VALVES prevent accidental reversal of tanks
3. Nitrous oxide CUTS OFF once oxygen flow stop
4. NO LESS THAN 30% oxygen can be delivered
5. SCAVANGING nose piece
6. SCAVANGER vent

Question 8

What drug is commonly used for intravenous sedation?

Answer 8

Midazolam, propofol

Question 9

What is the antidote for midazolam?

Answer 9

Flumazenil

Question 10

What are the complications of sedation?

Answer 10

• Nausea, vomiting

- Unintentional LOC

Question 11

What may prolonged exposure of nitrous oxide cause to the dentist/ staff?

Answer 11

• Liver damage
• Miscarriage
• Bone marrow suppression
• Addiction
• Carcinoma
• Birth defects

Question 12

What regulations are in place to safeguard the dentist and staff in regards to inhalation sedation?

Answer 12

Control Of Substances Hazardous to Health (COSHH)