Sedation and GA BRIEF questions Flashcards
Briefly what are the stages of NO sedation?
At what stage and planes do we have to stay within during NO sedation?
What is this sedation level known as?
What is this level of analgesia known as and why?
-Stage 1, Plane I and II
-Conscious Sedation (No loss of consciousness - pt is aware but relaxed)
-Relative Analgesia (only partial analgesic effect
what is the dose to achieve conscious sedation, and what is the dose to maintain it with NO?
40-50%, then 20-25% to maintan
What happens in Stage 1 Plane I NO sedation?
- Increased pain threshold
- Vitals intact
- Reflexes unaffected
- paraesthesia (tingling sensation on lips, fingers, toes)
- feeling relaxed
-Conscious communication
-Vasomotor - feeling of warmth
What happens in Stage 1 Plane II sedation?
Same as stage 1 plane I, +
- further relaxation
- floaty, euphoric feeling
- reduced blink rate
- reduced pharyngeal reflex
- can maintain open mouth
- may have some amnesia + telescoping of time (can be beneficial)
- may have flushing of face or extremeties
How may you be able to tell if a pt is going into Stage 1 plane III?
-may not be bale to maintain open mouth
- may be sleepy, sweaty or nauseous
- may not respond verbally to painful stimuli
- reduced pharyngeal and laryngeal reflexes
Should you do NO sedation in a pt with air filled cavities (Eg. Ear infection, bowel obstruction) and why?
No
-NO has a very low blood-gas solubility ratio compared to nitrogen (15-30x quicker)
-the air-filled cavities will have nitrogen in them
-> NO enters the cavity 15-30x quicker than nitrogen, which can cause pressure/volume increases in the cavity
Does NO biotransform in the body when it is inhaled?
No, there is no biotransformation in the body
Low blood-gas solubility -> has rapid onset and recovery
It is excreted Unchanged via the lungs
Can you use NO in a pregnant patient?
Yes, but avoid in 1st Trimester
(NO passes readily through placenta)
Indications for nitrous oxide sedation
- able to cooperate with tx (masks and instructions)
- mild-moderate fear or anxiety
- sensitive gag reflex
- intolerance to long appointments
What are TRUE contraindications for nitrous oxide sedation?
- Airway blockage (eg. cold, obstructed passage)
- Psychiatric disorder (can’t judge whether their reactions are due to NO or not)
-Bleomycin chemotherapy - MTHFR* deficiency
What are some cautions / relative contraindications for NO use?
- Pre-cooperative child (<3yo)
- uncooperative pt
- requiring extensive or very complex tx
- Conditions with trapped gas (eg. ear infection, bowel obstruction)
-Claustrophobic
-significantly medically compromised
-Pregnancy 1st trimester - Pt at risk of bone marrow suppression from NO - eg. Vit B 12 or Folate deficiency
How do you end the course of NO sedation? why?
administer 100% oxygen for 3 mins and seat the child for a few mins after the procedure
to prevent diffusion hypoxia (although, it is not a significant clinical problem)
what can cause complications with NO sedation?
-over-sedation
-lack of monitoring
-interactions with other medications
what are some possible adverse reactions to NO?
-nausea and vomiting
-dizziness, light headedness
-over-sedation
-Hypoxia
-Pressure/volume change in gas-filled cavities
-bone marrow suppression from chronic use
what is an occupational hazard of the use of NO?
chronic exposure can cause haematopoiesis and myeloneuropathic disorders
Advantages of NO
-non-invasine
-safe when administered correctly
-mild analgesia
-anxiolytic/sedative
-minimal impact on reflexes
-Vitals intact
-easily titrated
-rapid onset and recovery
Disadvantages of NO
-need cooperation with mask
-mask can interfere with procedure
-continuous administration - need to monitor
-possibility of occupational hazard
-may still need behaviour management
-cost for the practice
Indications for Oral sedation?
-anxiety
-co-operative
-when other routes are undesirable / not possible
Contraindications of oral sedation
-unable to take medication
-medical issues/interactions
-use w precaution in children under 6
Indications for IV sedation
-anxiety
-invasive procedure of short duration (eg. one exo)
contraindications for IV sedation
-inability to tolerate IV access
- medical issues or interactions
-use w precaution in children under 6
some examples of sedative agents used
-benzodiazepines
-antihistamines
-opioids
-ketamine
-barbiturates
Indications for GA for paediatric dentistry?
-very anxious child
-moderate - extremely uncooperative
-lack of cooperation due to psychological or emotional maturity
-not responsive to other modes of behaviour management
-extensive surgical treatment
-when prompt tx of acute condition is required (eg. dental abscess threatening patency of airway)
contraindications for GA in paeds pts
-medical issues where risk outweigh benefits
Is GA safe for paeds pts?
is regarded extremely safe, however, there can always be risks
How should you tx plan if a child is requiring GA?
Effort should be made that there be only one GA
-> tx planning should take the GA session into account
