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5th yr- AMS > Sedation technique > Flashcards

Sedation technique Flashcards

1
Q

What can sedation be used to do

A
  1. Manage dental treatment phobia
  2. Suppress the gag reflex
  3. Reduce anxiety and discomfort for patients undertaking difficult procedures
  4. Treat patients with anxiety induced medical conditions
  5. To treat patient with mild to moderate learning difficulties
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2
Q

What are the advantages of intravenous sedation

A
  1. Much safer than general anaesthetic when performed correctly
  2. Is an outpatient procedure
  3. Patients generally feel a dramatic reduction anxiety
  4. Generally makes patient more compliant with treatment
  5. Can make treatment easier due to reduced need to manage anxiety
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3
Q

What is a unique advantage of IV sedation over inhalation sedation

A

Patients forget most unpleasant experiences in IV sedation

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4
Q

What are the disadvantages of intra venous sedation

A
  1. Patients do not always respond predictability
  2. Retrograde amnesia means patients anxiety isn’t cured
  3. Not guaranteed that treatment will be possible
  4. At the second visit patient may think they were asleep in the last visit
  5. Increased risk of medical complications
  6. Oral access may be compromised
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5
Q

What are the stages of intravenous sedation

A
  1. Pre assessment (separate visit)
  2. Pre op checks
  3. Pre op preparation for you and patient
  4. IV access
  5. Sedation
  6. Clinical procedure
  7. Recovery
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6
Q

What do we need to be monitoring during the clinical procedure under sedation

A
  1. BP
  2. Heart rate
  3. O2 saturation
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7
Q

What do the pre op checks include

A

Checking:
1. Equipment
2. Drugs in date, right amount, in correct place
3. staff ready
4. Treatment plan
5. Medical history changes
6. Escort present and appropriate
7. Consent appropriate an sup to date
8. Base line observations

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8
Q

What are the baseline observations we record during pre op checks

A
  1. General appearance
  2. Blood pressure
  3. Pulse
  4. Respiratory rate and oxygen saturation
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9
Q

What pre op preparation do you need to do

A
  1. Do you have all the equipment required to complete the procedure
  2. Are you competent enough to do the procedure
  3. Are the relevant investigation available
  4. Have you planned for any complications
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10
Q

Can a patient consent once they have had the sedation drug

A

no

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11
Q

What pre op prep do we need from the patient

A
  1. Pre op checks are within acceptable limits
  2. Patients has fasted as appropriate
  3. Topical skin anaesthesia if required
  4. Does pt need a toilet break
  5. Is pt aware of what is planned for the session
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12
Q

If a pt is diabetic what else might we check pre op

A

Pre op blood glucose

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13
Q

What drugs do we use for sedation

A

Midazolam 5mg in 5ml

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14
Q

In regards to the drugs what do we need to prepare post op

A
  1. PPE
  2. Label syringes
  3. Check drug type, concentration and expiry date
  4. Draw up saline and midazolam into appropriately labelled syringes
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15
Q

At the LDI what is our preferred concentration of midazolam

A

1mg per ml

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16
Q

Where can we cannulate for IV sedation

A
  1. Antecubital fossa
  2. Dorsum of the hand
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17
Q

Name the 2 veins we tend to use for IV sedation

A
  1. Basilic vein
  2. Cephalic vein
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18
Q

Talk through the pathway of the basilica vein

A
  1. Ascends along the medial surface of the forearm near the elbow
  2. Changes to a position in front of the medial epicondyle where is is joined by the median cubital vein
  3. Runs along the medial margin of the biceps muscle to the middle of the upper arm
  4. Pierces the deep fascia to run alongside the brachial artery becoming the axillary artery
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19
Q

Talk through the pathway of the cephalic vein

A
  1. Ascends on the front of the lateral side of the forearm to the front of the elbow
  2. Ascends along the lateral surface of the bicep muscle to the lower border of the pectorals major muscle
  3. Pierces the clavipectoral fascia and passes beneath the clavicle
  4. Terminates in the axillary vein
20
Q

What does the cephalic vein communicate with

A

The basilica vein through the medial cubital vein

21
Q

What are found at the termination of the cephalic vein

A

Valves

22
Q

How can valves cause a problem during IV sedation

A

The sharp angles and calves may hinder her passage of a catheter along the cephalic system

23
Q

What are the advantages of using the antecubital fossa

A
  1. Less vulnerable to vasoconstriction in cold weather
  2. Usually bigger and well tethered veins which are easier to cannulate
  3. May be less painful than dorsum of the hand
24
Q

What are the disadvantages of using the antecubital fossa

A
  1. Vein may be less visible particularly with increased BMI
  2. Brachial artery and median nerve are medial to bicep tendons and we do not want to cannulate this
  3. May be less obvious if the cannula is incorrectly placed
25
Q

What do we need to place and where before cannulating on the dorsum of the hand

A

Need to place a tourniquet around the lower forearm above the wrist

26
Q

What are the advantages of using the dorsum of the hand fro IV sedation

A
  1. Veins tend to be more visible
  2. Not likely to damage important vessels or nerves
  3. May be more obvious is cannula is incorrectly placed
27
Q

What are the disadvantages of using the dorsum of the hand fro IV sedation

A
  1. Vulnerabel to vasoconstriction in cold weather
  2. Usually smaller and more mobile veins which are harder to cannulate
  3. Tends to be more painful
28
Q

What can we do if we want to cannulate the dorsum of the hand but it was cold outside

A

We can place the patients hands in hot water to help ease the vasoconstriction

29
Q

What equipment do we need for the provision of dental IV sedation

A
  1. Tourniquet
  2. Midazolam 5mg per 5ml ampule
  3. Filter needle
  4. Syringe
  5. safe snap ampule to open midazolam
  6. sodium chloride for saline flush
  7. Timer
  8. Sterile gloves
  9. Cannula
  10. Skin prep
  11. Dressing
  12. Reversing agent
30
Q

What do we want to do to prepare for intravenous access

A
  1. Take your time
  2. Look and feel for a good vein
  3. Occlude the venous return
  4. Gently tap and rub over the vein
31
Q

How can we occlude the venous return

A
  1. Tourniquet
  2. Nurses hand
  3. Pressure cuff
32
Q

What can we do if we have problems finding a vein

A
  1. Warn the hand in water
  2. Consider inhalation sedation to help vasodilate the veins
33
Q

How do we check the cannula is correctly placed

A
  1. There should be no haemoatoma around the insertion site
  2. Flush the cannula with saline via the portal (at least 2ml)
  3. If there is swelling pain or resistance cannula may be incorrectly placed
34
Q

What 3 signs suggest cannula may be incorrectly placed

A
  1. Swelling
  2. Pain
  3. Resistance
35
Q

Talk through the steps of sedating the patietn following cannulation

A
  1. Check observations before commencement
  2. Make sure syringe is firmly attached to the cannula
  3. Start the timer
  4. Give 1mg of midazolam iv slowly and wait to observe the effect
  5. Titrate the dose against the clinical effect
  6. Give additional 1mg increment as required
  7. Be patient
36
Q

How long do we wait between each 1mg increment

A

Wait at least a minute to let the drug travel to the brain

37
Q

Which patients may taker longer to exhibit an effect to midazolam

A
  1. Patients with high alcohol tolerance
  2. Patients who have previously taken midazolam
38
Q

What are we looking for when assessing clinical effect

A
  1. Relaxed demeanour
  2. Slurred speech
  3. Delayed response to questions
  4. Comfortable about starting treatment
  5. May complain of itchy nose and leg over
39
Q

What signs may we look for when assessing the clinical effect of midazolam

A
  1. EVE’s sign
  2. Verrill’s sign
40
Q

What is EVE’s sign

A

Asking the patietn to touch their nose which they may not be able to locate

41
Q

What is Verrill’s sign

A

Pulpil being partially cloaked

42
Q

What must we be aware of when carrying out treatment under sedation

A

Airway is partially compromised
Gag and cough reflexes can be suppressed

43
Q

How many people do we need to operate safely under sedation

A

3
you
your nurse to assist
another to monitor the patient

44
Q

How do we manage the sedated patient during treatment

A
  1. positive dialogue
  2. Be authoritative
  3. Speak clearly and firmly
  4. Tell the patient what you are going to do and ask for permission
45
Q

Do we give a reversing drug to speed a patients recovery from midazolam

A

no not routinely

46
Q

How do we go about recovery post sedation

A
  1. Leave the cannula in place until ready for discharge
  2. Make sure observations are normal fro patients
  3. Discharge not until at least 1 hour after last increment of midazolam
  4. Ensure patient is able to stand and walk unaided
  5. Give. post op verbal and written instruction to escort

5th yr- AMS (11 decks)

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