Sedation - Paeds Flashcards
What 3 factors are important during an assessment of a paediatric patient for conscious sedation?
History
- pain: asymptomatic? acute? = affects timing and tx options
- anxiety: general or specific? mild or severe?
- DH: past traumatic experiences? what’s worked well for px in past?
- MH: Mouth breather? intellectual impairment?
Patient Factors - what is the px coping style?
Goals - what tx do they want? do they just want tx or do they want to address the anxiety? what motivates px?
What is understanding dependant on?
age and stage of development
Define a monitor coping style
require lots of detail, understand what is going on and to consider it.
Define a blunter coping style
Don’t want to be involved in what’s going on/know what’s happening
List methods of pain and anxiety management and Gove examples. (4)
• Nonpharmacological behaviour management
- CBT, Tell, show do, Hypnosis
• Local anaesthetic - With good behaviour management, hypnosis/relaxation and CBT LA is manageable.
- An alternative is to use the wand = useful for children anxious by traditional methods/appearance of LA.
• Sedation
- Inhalation, IV, Oral/transmucosal
• GA
What are the paediatric indications for inhalation sedation? (6)
• Age – must be able to understand/be comfortable with nasal breathing and hypnotic suggestion.
• Anxiety level – mild/moderate (helpful for needle phobia as no IV)
• Management of gag (not suitable if this is the only indication as relaxation exercises can also work)
• Medical considerations - useful for conditions which are worsened by stress i.e asthma or had positive experiences on IH sedation before.
• Previous DH – useful for those who have had positive experiences on IH sedation before
• Dental needs – depends on what treatment i.e. a young children with high volumes of unpleasant treatment or difficult treatment on any child (extractions, surgicals)
What are the paediatric contraindications for inhalation sedation? (6)
• Age – child cannot understand/cooperate with sedation/nasal breathing.
• Anxiety level – extreme (unless the child is older and cannot toleate IV)
• Medical considerations - intellectual impairment inhibits understanding and susceptibility to hypnotic suggestion, has a nasal blockage or are mouth breathers etc
• Previous DH – previous unsuccessful attempts or fearful of the nasal hood
• Dental needs – Tx of the maxillary incisors can interfere with the nasal hood
• Patient choice – cannot force px’s
What is the minimum age considered for inhalation sedation?
4/5/6 - varies depending on px
What should be involved in consent for inhalation sedation? (5)
• Explore how the child will feel i.e. tingles, P&N
• Reassure child/parent that they will go back to normal after treatment
• Ensure child/parent understands that they will need additional LA etc.
• Get parent and child to repeat the information back to you to assess understanding.
• Provide pre&post op instructions
What patient instructions are provided before inhalation sedation? (3)
- Advise px to have a light meal before tx
- Ensure no pregnant adult to accompany child
- If child has a blocked nose = no Tx on the day
What post-op instructions are provided after inhalation sedation?
Ensure supervision for the rest of the day
- however child can go back to school if the teachers are informed
Describe the way in which we would provide the sedative during inhalation sedation. (4)
Turn flow to 5/6l per min using 100% oxygen
After a few mins (get the child settled) turn oxygen down to 90%
After another 1 min turn the oxygen down to 80%
- Can increase the nitrous oxide in 5% increments after this stage and monitor for relaxation.
Describe how we carry out the recovery process during inhalation sedation. (4)
- Once Tx completed/near the end = increase oxygen to 100%
- Allow 100% oxygen to be breathed for 2 mins before taking the nasal hood off
- After the nasal hood is removed allow px to relax for a few mins before getting them to sit up
- Once the child is sat up; communicate, encourage, praise and provide post-op instructions.
What IV sedative is commonly used for paediatric sedation?
Propofol
What are the indications for use of intravenous sedation in paediatric patients? (5)
• Age – (adolescents) 12 or above
• Anxiety – moderate to severe
• Medical conditions worsened by stress i.e. asthma or if they have generalised anxiety
• Previous dental history – if they’ve had previous difficult experiences or if they have a generalised dental phobia or phobia of Intra-oral injections
• Dental needs – depends on what treatment i.e. high volumes of unpleasant treatment or ortho extractions in an adolescent with no previous tx history.
