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BDS4 Sedation Symposium > Sedation in Special Care > Flashcards

Sedation in Special Care Flashcards

1
Q

What are some the problems in treating Special Care patients in dentistry?

A

Communication
Anxiety (due to lack of understanding)
Moving target
Perception of reality
Previous experience

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2
Q

Which congenital movement disorders can make dental treatment difficult?

A

Muscular dystrophy (breathing issues)
Cerebral Palsy
Multiple Sclerosis
Parkinson’s Disease
Huntingdon’s Chorea (learning difficulties)

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3
Q

What an be the cause of an acquired movement disorder?

A

Head injury

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4
Q

How are patients with involuntary movements managed?

A

Assessment:
Mental and physical status
Anxiety
Pain experience

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5
Q

What are the types of learning difficulties?

A

Congenital- syndromic/non-syndromic

Acquired- trauma, infection, CVA, alzheimers

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6
Q

What are the considerations for management of patient with learning difficulties?

A

Will behavioural management be possible?
-> Many patients can be treated with TLC

Is pharmacological management needed?

Sedation or GA or both- based on patient understanding/pain experience

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7
Q

What can be done if patient not competent to give consent for sedative treatment? (AWI 2000)

A

Medically qualified or appropriately trained dentists
can complete form allowing treatment (Lasts up to 36 months)

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8
Q

What are the types of conscious sedation techniques?

A

Inhalational
Intravenous
Oral
Trans-mucosal- rectal, intranasal, sublingual

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9
Q

What should be considered when choosing sedation technique?

A

Patient co-operation (if none- GA)
Degree of anxiety
Dentistry required
Skills of the dental team
Patient’s previous experience
Facilities available
Anaesthetist required?

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10
Q

What are the advantages of IS in special care?

A

Useful for anxiety relief
Rapid recovery
Flexible duration
No needles
Safe

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11
Q

What are the disadvantages of IS in special care?

A

Keeping nasal hood in place

Less muscle relaxation

Coordination of nasal breathing when mouth open (wont be sedated)

Requires cooperation and understanding of nasal breathing instructions

Less useful if very anxious

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12
Q

What are the ADV of IV sedation in special care?

A

Good sedation achieved
Less cooperation needed (still need to insert cannula)
Muscle relaxation

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13
Q

What are the DIS of IV sedation in special care?

A

Baseline readings required

IV Cannulation required

Difficulty assessing sedation level (esp non-verbal patients)

Behaviour during recovery- uncontrolled movements/patient upset

Not suitable for patients with swallowing difficulty

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14
Q

What can be used for IV sedation in special care?

A

Midazolam

Propofol- anaesthetic agent that can cause sedation

Multiple agents- can cause deep sedation (not in UK)

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15
Q

What are the features of propofol?

A

Uses pump

Fast acting

Can be topped up

Quick recovery

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16
Q

What must we consider to ensure sedation is safe in special care?

A

Swallowing
Airway
Liver
Medication interactions
ASA class

17
Q

What is used in Oral/Transmucosal sedation?

A

20mg of midazolam liquid achieves same level of sedation as IV)

-> this is not premed

18
Q

What are the advantages of oral and transmucosal sedation in special care?

A

Avoids cannulation
Can make induction more pleasant
Better cooperation
Better future behaviour

19
Q

What are the disadvantages of oral and transmucosal sedation in special care?

A

Baseline readings required
Bitter taste / stinging
Lag time- 30 mins
Untitrateable- unrpredictable
Difficulty in monitoring level of sedation
Behaviour in recovery
Cannula still needed after sedation

20
Q

Why is a cannula still needed in O/T sedation?

A

For easy access to allow for reversal

21
Q

How is intranasal sedation delivered?

A

Very concentrated midazolam is given via syringe with atomiser
-> Absorbed via nasal mucosa
-> works in 7 mins- bypasses first pass metabolism
-> reliable level of sedation

22
Q

What is the outcome of sedation based on and what are the options?

A

Degree of cooperation! Options:

All treatment completed under sedation (complicated treatment may even be possible)

Some sedation/some GA
-> exam, scale and polish- assess cooperation then refer for GA if required

Can enable other treatment from other disciplines

23
Q

Why may extraction be easier than restoration in some special care patients?

A

Uncontrolled movements are more acceptable when doing extractions

24
Q

What must we consider when placing restorations in special care patients

A

Will patient allow oral hygiene?
Are carers interested in providing oral hygiene?
Are the carers capable of providing oral hygiene?

BDS4 Sedation Symposium (8 decks)

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