Sedation - Special Care Flashcards
What problems are associated with providing dental treatment for a special care patient? (5)
Communication
Anxiety
Unable to sit/cooperate for dental treatment
Perception of reality
Previous experience
List congenital/genetic causes of movement disorders. (5)
- Muscular dystrophy
- Cerebral Palsy (uncontrolled movements)
- Multiple Sclerosis
- Parkinson’s Disease
- Huntingdon’s Chorea
List acquired causes of movement disorders. (1)
head injury
List congenital/genetic causes of learning difficulties. (2)
- Syndrome
- Non-syndrome
List acquired causes of learning difficulties. (4)
- Trauma
- Infection
- CVA
- Alzheimer’s
How is oral sedation carried out?
Patient drinks oral midazolam (20ml) Infront of dentist
- not the same as premed
What are the advantages of oral sedation? (4)
• Avoids canulation – cannot tolerate canula = indication for use
• Can make induction more pleasant
• Ensure better px coordination
• Improves future behaviour
What are the disadvantages? (7)
• Requires baseline readings (monitored throughout)
• Takes 30 mins to be absorbed and act on sedation levels
• Poor taste – bitter or stinging
• Untitratable
• Difficult to monitor level of sedation
• Difficulty in controlling behaviour during recovery
• Unpredictable - should be avoided where possible
What method of sedation Is commonly used in special care?
transmucosal sedation - intranasal
How is intranasal transmucosal sedation carried out?
Concentrated midazolam squirted into the nose via a syringe with an atomiser (creates fine mist which attaches to the nasal mucosa)
What are the advantages of intranasal transmucosal sedation? (6)
• Avoids first pass metabolism = quicker and reliable
- Sedated within 7 mins
• Sedation comparable to the dose required since no FPM
• No canulation = more cooperation
•. Can make induction more pleasant
• Ensure better px coordination
• Improves future behaviour
What are the disadvantages of intranasal transmucosal sedation? (4)
• Doesn’t completely avoid canulation as patients require canula once sedated to allow easy access if they become oversedated as we need to reverse it.
•. Poor taste – bitter or stinging
• Untitratable
• Difficult to monitor level of sedation
• Difficulty in controlling behaviour during recovery