Sedation & GA Flashcards
- What is the definition of conscious sedation?
- A technique un which the use of drugs or drugs produces a state of depression of the CNS enabling tx to be carried out but during which verbal contact wiht the patient is maintained throughout.
- The level of sediation means that the patient remains conscious, retains protective reflexes and is able to understand and respond to verbal commands
The drugs and techniques sued to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render unintended loss of consciousness unlikely
What is GABA?
Gamma-aminobutyric acid
Gamma-aminobutyric acid (GABA) is a neurotransmitter, a chemical messenger in your brain. It slows down your brain by blocking specific signals in your central nervous system (your brain and spinal cord). GABA is known for producing a calming effect.
What is GABAs function?
Has a calming affect
- Inhibitory neurotransmitter in the CNS
- It acts to inhibit nerve transmission in the brain calming the nervous activity
- (Benzodiazepines act on receptors in the CNS to enhance the effects of GABA in the cerebel cortec and motor ciruits this inhibiting CNS neurotransmitters producing a sedative effect.
What are the indications for inhalation sedation?
- Medical conditions which are aggrevated by stress. Epilepsy, hypertension, asthma
- Dental. Unpleasant or traumatic procedures
- Social. Dental phobia, high levels of dental anxiety or prominent gag reflex
- What are the contraindications for inhalation sedation?
- Severe or uncontrolled medical conditions, mental or physcial disability or psychiatric problems
- Unable to nose breath. Blocked nasal airway, common cold/flu, tonsillitis, poor co-operation to nose or mouth breath(must be able to co-ordinate nasal breathing with mouth open open hard for children)
- Narcolepsy, Hypoparathyroidism or pregnancy (espically 1st trimester)
- Severe COPD
- Unwilling and unco-operative
- Dental procedure too difficult for LA alone
What are the indications for intravenous sediation?
- As for inhalation sediation plus also useful for patient prone to fainting
- Conditions with poor co-operation such as mild to moderate movement or learning difficulties (spacisty disorder e.g cerebral palsy or Parkinson’s disease.
- N.B Doesnt work so well for gagging patients
What are the contraindications for IV sediation?
- Severe or uncontrolled medical conditions, mental or physcial disabilities or psychiatric problems
- Severe COPD
- Extremes of age <12
- Unaccompanied patients
- If procedure is too long for IV sediation >50mins
- Unwilling or unco-operative patients
- Dental procedure too difficult fro LA alone
- Certain medications erythromycin
- Intracranial pathology - likely already being monitored using AVPU and sediation with further decrease alterness, skew AVPU results and make monitorign the patient difficult
- Myasthenia gravis
- What are the safety features of the (quantiflex) machine present when giving inhalation sedation?
- Oxygen flush button
- Reservoir bag
- Minimum oxygen 30%
- Air entrainment valve
- Different coloured cylinders - black for oxygen and blue for NO2 so cant get mixed up and can only be attached one way.
- Nitrous oxide stops when oxygen stops
- Oxygen monitor built in - fail safe at 40psi
- One wat expiratory valve
- Pressure reducing valves
- What are the advantages of using inhalation sedation over IV midazolam?
- Quicker onset 2-3minutes and peak action 3-5 minutes
- Rapid recovery
- Can increase and decrease the degree of sedation
- NO2 is not metabolised so safer than midazolam
- Less post-operative effects
- No needles or cannulas (issue for patients scared of needles)
- No amnesia
- Adult patients dont require a chaperone
- Can be used on children under the age of 12
What is the half life of midazolam?
90-150 minutes
GIve 6 things you assess a patient before IV sedation?
- Heart rate
- Oxygen saturation
- Blood presssure
- Height and weight for BMI
- ASA classification
- MH and Drug history
- Co-operation level
What is the ASA classification?
American society of anaesthesiologists
Is a way of classifying how fit and well a patient is. It can be used to determine what treatment is possible, using what techniques and in what setting. Including with sedation.
What are all of the ASA classifications and give an example for each?
Class l - normal healthy patient
class ll - mild systemic disease. eg well controlled asthma and epilepsy, type 2 diabetes, pregancy, borderline hypertension.
Class lll - Severe systemic disease. Eg stable angina, COPD, Type 1 diabetes, Hisotry of MI (more than 3 months)
Class lV - Severe systemic disease that is a constant threat to life e.g severe COPD and unstable angina, recent MI or stroke (less than 3 months). Marked hypertension
Class V - A moribound patinet who is not expected to survive without the operation.
Class Vl - Declared brain dead patient whos organs are being removed for donor purposes
What do you monitor in a sedated patient and what time intervals
- Heart rate
- Blood pressure
- oxygen saturation
- Monitor every 5 minutes
Patient is having his lower left 3rd molar removed under IV sedation.
1. Why is written consent gained prior to the sedation process?
- Legal requirement that written consent is obtained where concious sedation is to be used
- Consent process starts at a seperate appointment prior to tx unles there is exceptional circumstances (e.g acute pain) which allows the patient sufficent time to consider the information provided
- The consent should also be reconfirmed at least verbally on the day of the procedure
- Consent is gained prior to the sedation process as once the patient has been administered with the sedative they no longer have the capacity to consent
