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Sedation - Intro, monitoring Flashcards

1
Q

Valium

A

Diazepam

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2
Q

Ativan

A

Lorazepam

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3
Q

Halcion

A

Triazolam

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4
Q

Versed

A

Midazolam

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5
Q

Ambien

A

Zolpidem

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6
Q

What kind of sedation is best for anxiety relief?

A

Enteral sedation

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7
Q

What is a good route of sedation to use as premed for other routes?

A

Enteral sedation (oral/rectal)

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8
Q

What is the worst kind of sedation for pharmacological restraint?

A

Enteral sedation

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9
Q

What is pain?

A

That which hurts, is unpleasant

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10
Q

Among pain, fear and anxiety, which one is a short-lived phenomenon?

A

Fear

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11
Q

Which one out of pain, fear and anxiety disappears when danger or threat passes?

A

Fear

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12
Q

Which out of pain, fear and anxiety is a learned response?

A

Anxiety

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13
Q

Which one out of pain, fear and anxiety is anticipatory?

A

Anxiety

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14
Q

Diminution or elimination of pain is known as..

A

Analgesia

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15
Q

Elimination of sensation in one part of body

A

Local anaesthesia

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16
Q

Topical application and regional injection of drug are forms of

A

Local anaesthesia

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17
Q

Grades of sedation

A

Minimal Sedation < Moderate Sedation < Deep Sedation < General Anaesthesia

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18
Q

In CA, what is the age of a patient at which they are given Pediatric Oral Conscious Sedation?

A

< 13 years

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19
Q

Administration of an oral medication at dose that exceeds maximum dose recommended by FDA

A

Adult Oral Conscious Sedation

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20
Q

3 things sedative modality is dependent on

A
  1. Patients degree of anxiety
  2. Clinician’s level of training
  3. The procedure
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21
Q

Sort drugs used for anxiety relief in ascending order of morbidity

A

Nitrous oxide < Oral premedication < Parenteral premedication < Deep sedation < GA

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22
Q

Goals of sedation

A
  1. Fear and anxiety relief
  2. Stress reduction
  3. Improved pain control
  4. Enhanced patient cooperation
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23
Q

Is Anaesthesia indicated in gagging?

A

Yes

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24
Q

Indications for sedation

A
  1. Anxiety or fear in adults
  2. Young children
  3. Mental or physical disability
  4. Medically compromised patient
  5. Extensive invasive procedure
  6. Extended care during one appointment
  7. Gagging
  8. LA problems
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25
Q

Is sedation indicated in anxious or fearful children?

A

No

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26
Q

Lost the different techniques of sedation

A
  1. Iatrosedation
  2. Inhalation
  3. Oral
  4. Rectal
  5. Intramuscular
  6. Intravenous
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27
Q

2 types of rectal sedation

A
  1. Sublingual

2. Intranasal

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28
Q

Types of intramuscular sedation

A
  1. Subcutaneous

2. Submucosal

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29
Q

Is Local Anaesthesia part of sedative regimen?

A

Yes

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30
Q

What % of patients are terrified of dental treatment?

A

3%

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31
Q

What % of patients are very afraid of dental treatment?

A

4%

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32
Q

What % of patients are somewhat afraid of dental treatment?

A

13%

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33
Q

In patients with dental anxiety, does LA work?

A

Yes, but only in >/= 50%

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34
Q

Est. Dental anxiety incidence in USA

A

16.4%

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35
Q

Country with least dental anxiety incidence

A

Denmark

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36
Q

Country with highest dental anxiety

A

The Netherlands

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37
Q

Legislative issues in sedation

A
  1. Restricted vs exempt techniques
  2. Training requirements
  3. Performance requirements
  4. Maintenance requirements
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38
Q

Standards vs Guidelines vs Statements

A

Standards are the only things to be strictly followed in order to maintain lawful activity

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39
Q

Most up to date guidelines among ADSA, ADA and ASA

A

ASA - last amended 10/2010
ADA - 10/2007
ADSA - 1988

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40
Q

What all do you monitor during anaesthesia?

A

Oxygenation
Ventilation
Circulation
Temperature

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41
Q

According to ADA, for minimal and moderate sedation, how do you evaluate an ASA I patient?

A

Review current medical history

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42
Q

According to ADA, for minimal and moderate sedation, how do you evaluate an ASA II patient?

A

Review current medical history

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43
Q

According to ADA, for minimal and moderate sedation, how do you evaluate an ASA III patient?

A

Medical consult

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44
Q

According to ADA, for minimal and moderate sedation, how do you evaluate an ASA IV patient?

A

Medical consult

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45
Q

In what kind of sedation does the ADA not mandate the use of pulse oximetry to monitor oxygenation?

A

Minimal sedation

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46
Q

What should be done in both minimal and moderate sedation patients to monitor oxygenation, according to the ADA?

A

Colour of mucosa, skin or blood must be evaluated continually

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47
Q

ADA - only chest excursions need be observed to monitor ventilation. What kind of sedation?

A

Minimal sedation

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48
Q

ADA - what more needs to be done to monitor ventilation in moderate sedation?

A
  1. Auscultate breath sounds
  2. Monitor end-tidal CO2
  3. Verbal communication with patient
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49
Q

Difference between ADA circulation monitoring guidelines for minimal and moderate sedation

A
  • continual evaluation of HR and BP in moderate - if unable to tolerate, note in time-oriented record.
  • HR and BP - pre-, intra- and post-op readings noted in minimal sedation
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50
Q

During discharge, what two things should immediately be available in recovery area?

A

Oxygen and suction

51
Q

Should monitoring be continued when anaesthetic is no longer being administered?

A

Yes. - oxygenation, ventilation and circulation.

52
Q

When should you stop monitoring a patient who has undergone moderate or minimal sedation?

A

Only stop when patient is stable and ready for discharge.

53
Q

What are the required contents of documentation?

A
  1. Appropriate time-oriented reord
  2. Names of all drugs, including LA
  3. Monitored parameters
  4. Pulse oximetry, RR, BP
  5. Stable O, V and c before discharge
  6. Postop instructions
54
Q

How do you recognise deleterious trends during a procedure under anaesthesia?

A

Monitoring

55
Q

How do you detect acute emergencies when patient is sedated?

A

Monitoring

56
Q

How do you evaluate effect of the administered anaesthetic during a procedure?

A

Monitoring

57
Q

Face validity

A

If you cannot detect a problem it cannot be managed.

58
Q

What are the majority of emergencies during a procedure when a patient is sedated?

A

Respiratory, preventable.

59
Q

Descending order of % of damaging events in malpractice claims

A

Respiratory > Cardiovascular > Equipment

60
Q

What kind of respiratory event is becoming ever more dangerous in sedation?

A

Difficult intubation

61
Q

What cause of respiratory event is becoming less relevant?

A

Inadequate ventilation

62
Q

What are the most common causes of respiratory events?

A

Inadequate ventilation, esophageal intubation, difficult intubation

63
Q

In what kind of sedation is a patients response purposeful to verb or tactile stimulation

A

MOderate sedation

64
Q

In what kind of sedation is a pain stimulus required to elicit a response from the patient?

A

Deep sedation

65
Q

In what kind of sedation is a patient unarousable even with a painful stimulus?

66
Q

Under which kinds of situation could intervention to maintain a patent airway required?

A

Deep sedation and GA

67
Q

Methods of monitoring ventilation

A
  1. Chest excursion
  2. Reservoir bag movements
  3. Auscultation of breath sounds
  4. Capnography
68
Q

Instruments/equipment used to monitor ventilation

A
  1. Pretracheal stethoscope

2. End-tidal carbon dioxide detector

69
Q

What instrument can quickly detect partial airway obstruction and foreign matter in the airway?

A

Precordial stethoscope

70
Q

What is the pretracheal stethoscope also known as?

A

Precordial stethoscope

71
Q

What all can you measure with a pretracheal stethoscope?

A

RR and indication of ventilatory depth

72
Q

How long does the pretracheal stethoscope take to detect apnea?

73
Q

What is the major limitation of etCO2 detector?

74
Q

What is the ETCO2 detector great at doing?

A
  1. Confirming ET tube placememt

2. Accurate assessment of ventilation

75
Q

What are the stages of a capnogram?

A

Sea level - exhalation
Plateau level - alveolar plateau
Edge of plateau - end-tidal CO2
Cliff off plateau - inspiration

76
Q

What is used to monitor O2 sat?

77
Q

Methods of monitoring oxygenation

A
  1. Visual inspection

2. Pulse oximetry

78
Q

Is visual inspection useful while monitoring oxygenation?

A

No - poor sensitivity and high variability

79
Q

Can you dependably detect cyanosis by visual inspection?

A

No - late detection - 5g/dL

80
Q

What is a major concern during anaesthesia as far as oxygenation is concerned?

A

Oxygen delivery to peripheral tissues

81
Q

How do you measure oxygen delivery to peripheral tissues?

A

Product of cardiac output and oxygen content in the blood

82
Q

What does the pulseox do?

A

Rapid, continuous, noninvasive estimation of PaO2 hb

83
Q

How do you figure out the relationship between saturation of hb with o2 and the partial pressures of o2?

A

Oxyhb dissociation curve

84
Q

What is the safe level of O2 Sat?

A

95 +/- 4 %

85
Q

Normal content of O2 in blood

86
Q

How is O2 carried in blood?

A
  1. Oxyhemoglobin

2. Dissolved in plasma

87
Q

How many LED’s does a pulseox have?

A

2 - visible red light and IR radiation

88
Q

What is the wavelength of the visible red light LED in a pulseox?

89
Q

What is the wavelength of the IR Radiation LED in a pulseox?

90
Q

Reduced hemoglobin absorbs ______ light more

A

Visible red

91
Q

Oxyhemoglobin absorbs ______ light more

A

IR Radiation

92
Q

What are the 2 fundamental principles of Pulse Oximetry?

A
  1. Differential light absorption

2. Increased light absorption by pulsatile blood flow compared with CT, Bone, venous blood etc

93
Q

Basis of oximetry

A

Beer’s law

94
Q

Beer’s law

A

The intensity of transmitted light decreases exponentially as the concentration of the substance increases

95
Q

Does the pulse oximeter work on assumptions?

A

Yes - All pulses are arteriolar and all light passes through pulsatile beds with adequate normal hb.

96
Q

Does the pulse oximeter take into account dyes?

97
Q

Can Pulseox be used with nail polish?

98
Q

Can pulseox be used in severely anemic patients?

99
Q

Can pulseox be used when patient is constantly moving?

100
Q

Can pulseox be reliably used when there is electronic interference?

101
Q

Can pulseox be used when there is excessive ambient light?

102
Q

Why would there be poor perfusion in peripheral areas?

A
  1. Physical occlusion of blood flow
  2. Vaso constriction
  3. Hypotension
  4. Venous congestion
  5. Hypothermia
103
Q

What specific intervals should BP be taken at during GA?

104
Q

Methods used to monitor circulation

A
  1. Pretracheal stethoscope

2. BP device

105
Q

How do you detect arrhythmia in sedated patients?

A

Use pretracheal stethoscope

106
Q

How do you detect changes in heart tone in sedated patient?

A

Pretracheal stethoscope

107
Q

How is BP determined when using a BP device?

A

Listening to Korotkoff sounds

108
Q

What happens when the cuff used to measure BP is too small?

A

BP overestimated

109
Q

What happens when cuff used to measure BP is too big?

A

BP underestimated

110
Q

What is the ideal width of the cuff used in a BP machine?

A

20% wider than diameter of the limb

111
Q

Are manual or automatic devices better at detecting hypotension?

112
Q

Which one’s faster at determining BP - manual or automatic?

113
Q

Which one is sensitive to movement - manual or automatic BP device?

114
Q

In which patients do you place the BP cuff on forearm?

A

Obese patients

115
Q

Where do you place BP cuff in obese patients?

A

Forearm

Calf

116
Q

When do you feel for radial pulse return while measuring BP?

A

When you cannot hear Korotkoff sounds

117
Q

What do you do when you cannot hear Korotkoff sounds?

A

Feel for radial pulse return

118
Q

What does radial pulse return signify?

A

It correlates with systolic pressure

119
Q

When is ECG continuously displayed during sedation??

A

Patients with significant cardiovascular disease

120
Q

What kind of ECG is used for arrhythmia detection?

A

3 lead ECG

5 lead ECG

121
Q

2 instruments used to detect arrhythmia

A
  1. Pretracheal stethoscope

2. ECG - 3 lead, 5-lead

122
Q

What lead is used to take readings in 3 lead ECG?

123
Q

How do you detect ischemia in a sedated patient?

A

5 lead ECG

Sedation (3 decks)

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