Sedation Assessment

Question 1

What questions should be asked about the dental anxiety of a patient?

Answer 1

Nature of the fear

Phobia or anxiety?

General anxiety about whole experience, or specific to one thing?

Question 2

What aspects of a patients social history are important to know for a sedation assessment?

Answer 2

Occupation - work

Escort - to and from sedation

Alcohol - respiratory depression

Responsibilities - children, arrange a helper

Transport - can they get around after sedation

Age - extremes of age, wary

Question 3

What aspects of dental history should be considered for sedation assessment?

Answer 3

Referral source?

Previous bad experiences?

Any previous sedation or GA?

Symptoms
- acute
- chronic

Proposed procedure
- completed within 45 minutes
- can be given to those not necessarily anxious but for difficult to tolerate procedures

Question 4

What specifics to do with drugs / medications should we know for sedation assessment

Answer 4

Drug history - how long and what for?

Drug allergy - any previous allergies to treatments or drugs

Previous anaesthetic or sedation - good or issues

Recreational drug use

Question 5

What is an ASA I?

Answer 5

Normal healthy patient, non smoker, minimal alcohol

Question 6

What is an ASA II?

Answer 6

Mild systemic disease

Question 7

What is an ASA III?

Answer 7

Severe systemic disease; limits activity but not incapacitating

Question 8

What is an ASA IV?

Answer 8

Severe systemic disease: constant threat to life

Question 9

What is an ASA V?

Answer 9

Moribund: not expected to live >24hrs

Question 10

What ASA can be treated in primary and secondary care?

Answer 10

ASA I and ASA II - may be treated in primary care

ASA III - should be treated in secondary care

ASA IV - must be treated in secondary care

Question 11

Give some questions you would ask to gain more information about a patients asthma, relevant to dentistry

Answer 11

What drugs do they take, and how often

Reliever / preventer inhaler or combo?

Have they ever been hospitalised, or had any hypersensitivity reactions

Is it exacerbated by stress, especially dental anxiety or stress?

Question 12

What is a pharmacodynamic interaction?
What is a pharmacokinetic interaction?

Answer 12

PD is interactions between two drugs that have similar or antagonistic pharmacological effects

PK is one drug will alter the absorption, distribution, metabolism or excretion of another drug

Question 13

What vital signs need recording for sedation assessment?

Answer 13

HR, BP, O2 sat

BMI
- Weight cut off for sedation is BMI 35

Question 14

What are the ways to orientate a patient to the sedation setting?

Answer 14

Written pre and post op instructions

Introduction to staff and environment

Opportunity for questions

Consent