Sedation - Inhalation Flashcards

1
Q

What are the indications for inhalation sedation use in adults and children? (6)

A

• Anxiety – mild/moderate (doesn’t work for severe anxiety)
• Needle phobia – used alongside needle desensitisation
• Gagging – gas held to reduce gag reflex
• Traumatic procedures – just unpleasant even if person isn’t anxious
• Prevent medical conditions worsening if they are aggravated by stress e.g. asthma
• Used for unaccompanied adults requiring sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the contraindications for inhalation sedation use in adults and children? (6)

A

• Common cold = blocked nose
• Tonsillar/adenoidal enlargement = natural mouth breathers – need to breathe through nose!
• Severe COPD
• First trimester of pregnancy
• Fear of “mask” / Claustrophobia
• Patients with limited ability to understand what is required of them during the procedure (i.e. small children under 7 or those with learning difficulties)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What colour is the quantiflex oxygen flow meter?

A

black

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What colour is the nitrous oxide flow meter?

A

blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the accuracy of the oxygen and nitrous oxide flow meters?

A

+/- 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the minimum % of oxygen that the oxygen flow meter can deliver?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the functions of the 2 gas delivery hoses attached to the nasal hood?

A

One hose delivers fresh gases from machine
One hose delivers waste gas to scavenging system (waste nitrous oxide)

  • Non return valve in expiratory limb prevents rebreathing expired gases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many room air changes occur per hour and why are these carried out?

A

15 - to reduce the amount of nitrous oxide in the room air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name all 14 safety features that are present when carrying out inhalation sedation and what they are used for.

A

• Pin index system = prevents the wrong cylinder being attached

• Diameter index system = prevents cross connection of piping

• Minimum oxygen delivery = 30%

• Oxygen fail safe = operates when oxygen pressure < 40 psi

• Air entrainment valve - if gases fail, valve opens allows room air into circuit

• Oxygen flush button - flushes O2 35 l/min. (fast flowing)

• Oxygen monitor
• Reservoir bag - helps to monitor respiration

• Colour coding = ensure the tanks aren’t attached to the wrong tubes.

• Scavenging system = ensure nirous oxide not breathed into the atmosphere

• Oxygen & nitrous oxide pressure dials
• Pressure reducing valves

• One way expiratory valve - prevents rebreathing expired gases

• Quick fit connection for positive pressure oxygen delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the advantages of using inhalation sedation? (10)

A

• Rapid onset (2-3 mins)
• Rapid peak action (3-5 mins)
• Depth altered either way (increase or decrease)
• Flexible duration – can use as required
• Rapid recovery
• No injection (for the sedation but obviously LA still required depending on the procedure)
• Few side effects to patient
• Drug not metabolised – just breathe it out
• Some analgesia (though better for iscaemic than inflammatory pain) still nee LA.
• No amnesia – can remember the whole procedure = positive experience and might not need sedation next time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the disadvantages of using inhalation sedation? (8)

A

• Equipment expensive
• Gases expensive
• Space occupying equipment = large
• Not potent – only provides a little bit of sedation, px has to be willing and only mild/moderately anxious
• Requires ability to breathe through nose
• Chronic exposure risk – theoretical risk (eliminated by scavenger methods) to environment and staff.
• Staff addiction
• Difficult to accurately determine actual dose – can be leakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we know the patient is sedated enough? (17)

A
  • Patient relaxed/comfortable: floaty/daydreaming/detached feeling (mental &physical)
  • Patient awake and able to interact
  • Reduced blink rate
  • Laryngeal reflexes unaffected
  • Vital signs unaffected
  • Gag reflex reduced
  • Mouth should be able to open on request
  • Decreased reaction to painful stimuli
  • Decrease in spontaneous movements
  • Verbal contact maintained
  • Lessened awareness of pain
  • Paraesthesia – lips, fingers, toes, legs, tongue (tingling, pins&needles)
  • Lethargy
  • Euphoria
  • Warmth (take excess clothing off)
  • Altered awareness of passage of time
  • Small controllable “fit of the giggles”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the signs of over sedation? (9)

A
  • Mouth closing – repeatedly
  • Spontaneous mouth breathing
  • Nausea/vomiting
  • Irrational and sluggish responses
  • Decreased cooperation
  • Incoherent speech
  • Uncontrolled laughter, tears
  • Patient say they no longer enjoying the effects
  • Loss of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What pre-op instructions do we give patients before the sedation appointment? (8)

A

• Have a light meal before appointment (not directly before)
• Take routine medicines as usual
• Children accompanied by a competent adult
• Adults accompanied at their first sedation appt. afterwards may then attend alone
• Do not drink alcohol on day of appointment
• Wear sensible clothing
• Arrange care of children during and after your appointment
• Plan to remain in clinic for up to 30 minutes after treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the way in which we would provide the sedative during inhalation sedation. (5)

A

set mixture dial to 100% O2 ( flow to 5-6l per minute) and allow px to settle in dental chair

ensure px settled and comfortable with hood before proceeding – breathe only oxygen for about 1 minute

Reduce O2 by 10%

Wait 1 minute and repeat until reaches 80%

After O2 reaches 80%, reduce by 5% per minute until adequate sedation is reached.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In terms of sedation; What is carried out throughout? (4)

A

• Use semi-hypnotic suggestions in a calm/monotone voice (“you feel calm, relax, breathe in gently, visualise..”)

• Provide constant reassurance & hypnotic suggestion

• Monitor for signs & symptoms of adequate sedation

• Adjust level of O2 as required

17
Q

What must we do if a patient is over sedated?

A

increase O2 in 5-10% increments until satisfactory sedation

18
Q

what must we do if a patient is under sedated?

A

If under-sedated decrease O2 in 5% increments until satisfactory sedation

19
Q

Describe how we carry out the recovery process during inhalation sedation. (4)

A

• Gradually increase O2 by 10-20% per minute until 100% or you can just turn straight to 100%

• Administer 100% O2 for 2-3 minutes to prevent diffusion hypoxia (Diffusion hypoxia can occur with the administration of inadequate amounts of oxygen during or immediately after N2O anesthesia)

• Remove hood and turn gas flow off

• Return patient to upright slowly, give praise and reassurance

20
Q

What post-op instructions are provided after inhalation sedation? (4)

A

• Adult patients may leave unaccompanied at dentist’s discretion
• Child patients (<16 years) must be accompanied by a competent adult
• ask & discuss how patient felt procedure went
• Patients may feel shivery after I.S- reassure patient that this is common and passes quickly