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ISCE RESIT > SEDATION/CONSENT - STATION 2 > Flashcards

SEDATION/CONSENT - STATION 2 Flashcards

1
Q

what are the type of sedation methods available

A
  1. LA and Reassurance
  2. Premedication
  3. Inhalation Sedation
  4. IV Sedation
  5. Oral sedation
  6. General Anaesthesia
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2
Q

what are the type of conscious sedation methods used

A
  1. LA and Reassurance
  2. Pre Medication
  3. Inhalation
  4. Oral sedation
  5. IV sedation
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3
Q

of the conscious sedation which two methods are not widely used?

A
  1. oral sedation
  2. intranasal sedation
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4
Q

what is used for inhalation sedation?

A

Nitrous oxide and oxygen

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5
Q

what sedation methods would you use for mild anxiety

A

Inhalation Sedation
Pre Medication

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6
Q

what are the indications for inhalation sedation

A
  1. fear of needles
  2. ability to breathe through nose
  3. do not have a cold on day of treatment
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7
Q

what are the characteristics of Nitrous Oxide

A
  1. inhaled gas
  2. sweet smelling
  3. colourless
  4. heavy
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8
Q

what is the onset of Nitrous Oxide

A

rapid
3-5 minutes

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9
Q

what is the elimination speed for nitrous oxide

A

rapid

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10
Q

inhalation sedation overdose signs include

A

headache
nausea
vomiting

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11
Q

oxygen may need to be given as result of counteracting the side effects of inhalation sedation, what is the name of the condition being reversed

A

diffusion hypoxia

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12
Q

how do you treat diffusion hypoxia

A

100% oxygen administration should follow nitrous oxide cessation for 5 minutes

known as O2 flush

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13
Q

what are the indications for inhalation sedation

A

mild anxiety
needle phobia
patient not suitable for IV/GA
straightforward dental treatment

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14
Q

hat are the considerations for inhalation sedation?

A

Able to cooperate

age
learning disability
cognitive impairment
ability to tolerate mask
mask may impede access to anterior teeth

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15
Q

what are the contraindications of inhalation sedation

A
  1. COPD
  2. Recent eye or ear surgery - Nitrous oxide anaesthesia in the presence of intraocular gas can cause irreversible blindness.
  3. Mask Intolerance
  4. pregnancy - recommend 2nd trimester
  5. Vit B12 deficiency (NO depletes the body’s store of vitamin B12)

6.methotrexate interaction - drug holiday (to much toxicity)

  1. chemotherapy interaction
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16
Q

inhalation sedation requires the use of which equipment

A

A
RA (Relative analgesia) machine

gas cylinders or piped gases

Scavenging - is a means to collect and remove excess gases to prevent them from being vented back into the operating room.

monitoring for staff

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17
Q

intravenous sedation is delivered as an injection most commonly which drug is used?

A

midazolam

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18
Q

what level of anxiety must you have to be considered for IV sedation

A

Mild-moderate

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19
Q

how is midazolam administered

A

administered in to the vein via cannulation

introduce a cannula or thin tube into (a vein or body cavity).

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20
Q

do you require a escort for Intravenous sedation

A

Yes

the escort is required to follow rules to keep patient safe

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21
Q

Q
what is usually one of the side affects of IV sedation

A

Amnesia

22
Q

what drug is required to reverse the use of midazolam

A

Flumazenil in a dose of 0.15 mg is a safe drug that reverses the sedative effect of midazolam

23
Q

what are the indications of midazolam

A
  1. dental anxiety/phobia
  2. medically suitable
  3. social history
  4. unpleasant procedure
24
Q

what are the contraindications for IV sedation

A
  1. needle phobia
  2. medical reasons
  3. social reasons
  4. pregnancy - sedation during the third trimester of pregnancy for surgeries not related to delivery of the baby
  5. poor venous access
25
Q

what equipment is needed for IV sedation

A
  1. Midazolam

2.Flumazenil

  1. Labels for syringes
  2. Saline - sedation usually accompanied by hypotension, which reduces the amount of sedation able to be employed. Blood pressure is restored by the infusion of intravenous normal saline.
  3. pulse oximeter
  4. BP cuff and machine
  5. Tourniquet
26
Q

how many micrograms of midazolam is in 5 m

A

5 mg

27
Q

how many micrograms of flumazenil is in 5 ml

A

500 mg

28
Q

what factors can affect reading on a pulse oximeter

A

nail polish (dark)/gel/acrylic nails

finger tapping/playing with pulse oximeter

breath holding

cold hands

fasting - varies between units

29
Q

what are the signs of overdose with IV sedation (midazolam)

A
  1. loss of protective reflexes
  2. loss of consciousness
  3. decreased respiration
  4. decreased heart rate
30
Q

flumazenil is a reversal agent and it must be held in

A

stock

31
Q

flumazenil rescue is considered a

A

never event

32
Q

what is flumazenil

A

it is a benzodiazepine

33
Q

what medication is usually given as oral sedation

A

usually midazolam

delivered as a drink

34
Q

is oral sedation considered pre-med

A

no

35
Q

what must you do before you have given a patient midazolam as a form of oral sedation

A

must still cannulate for safety - rescue/reversal

must be proficient in IV technique

36
Q

how long does it take for the effects of oral sedation to work

A

Oral sedation means that the sedation drugs are swallowed as a tablet or liquid. It takes about 10 minutes for the effects of the drug to work. Once you are sedated, you will usually have a small cannula placed in the back of your hand or in your arm

37
Q

what is a typical regimen for premedication with diazepam

A

5 - 10 mg Diazepam

Last thing at night on the evening before the appointment

On wakening on the morning of the appointment
60 - 90 mins before the appointment

Prescribe only what is required

38
Q

diazepam is available in

A

2, 5, 10 mg tablets for oral use

39
Q

what are the indications for diazepam

A

Very anxious patients – may aid them attending the surgery or sleeping the night before

Patients when sedation is contraindicated:-

Medical reasons

Inability to get venous access – IV Sedation

Inability to breath through nose – RA

To “take the edge off” before more complex and prolonged procedures

40
Q

what are the contraindications for diazepam

A

Hepatic impairment
Renal impairment
Pregnancy
Breast feeding

41
Q

what are the cautions for the use of diazepam

A

Avoid prolonged use

Reduce dose in debilitated patients

Reduce dose in elderly

Respiratory disease

Patient compliance – taking at wrong time!

42
Q

Sedation standards and guidance

A

IACSDS

interollegiate
advisory
committee for
sedation in
dentistry
standards

43
Q

what is the definition of General Anaesthesia (GA)

A

A general anesthetic is a state of controlled unconsciousness,
affecting the whole body, so the patient does not move or feel
pain, with loss of protected reflexes

44
Q

what are the indications for GA

A

Lengthy or complex surgery

Very anxious / dental phobic patients who are unable to tolerate / cooperate with treatment under other modalities e.g. LA, oral, IV or nitrous oxide sedation

Patients with a profound learning disability who are unable to tolerate / cooperate with treatment under other modalities e.g. LA, oral, IV or nitrous oxide sedation

Multiple extractions in multiple quadrants

Severe trauma or acute dental infection

Cases where nitrous oxide or IV sedation is contraindicated or inappropriate

45
Q

what are the advantages of GA

A

Patient cooperation not required*

Patient unaware of the procedure taking place

Significant amount of treatment can be carried out in one attendance

May be able to co-ordinate interventions with other specialities

46
Q

what type of consent is needed when undergoing GA

A

‘Open’ consent often needed as cannot change the treatment plan half way through, or wake patient to discuss,

e.g. “EUA – examination under anaesthesia and dental treatment as deemed appropriate”. Some patients not happy to give ‘open’ consent which could result in e.g. more teeth extracted than first anticipated, or front teeth needing extraction

47
Q

what are the disadvantages/limitations of GA

A

Preoperative assessment(s) medical and dental needed

Needs careful treatment planning / all work to be done in one visit,

Treatment often has to be more radical to be done in one visit

Does not help the patient get over their fear / build confidence

Pre-op fasting and after care required

Risk (morbidity and mortality) of GA

48
Q

level of sedation

moderate sedation

A

Conscious sedation, depression of consciousness, patients respond purposefully to verbal commands

49
Q

level of sedation

deep sedation:

A

nearly unconscious, only has purposeful response to repeated and painful stimulation.

50
Q

Level of sedation

General anaesthesia:

A

completely unconscious, does not respond to any level of pain. The patient will require breathing assistance and cardiovascular function may be impaired

ISCE RESIT (4 decks)

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