Sedation technique Flashcards
What can sedation be used to do
- Manage dental treatment phobia
- Suppress the gag reflex
- Reduce anxiety and discomfort for patients undertaking difficult procedures
- Treat patients with anxiety induced medical conditions
- To treat patient with mild to moderate learning difficulties
What are the advantages of intravenous sedation
- Much safer than general anaesthetic when performed correctly
- Is an outpatient procedure
- Patients generally feel a dramatic reduction anxiety
- Generally makes patient more compliant with treatment
- Can make treatment easier due to reduced need to manage anxiety
What is a unique advantage of IV sedation over inhalation sedation
Patients forget most unpleasant experiences in IV sedation
What are the disadvantages of intra venous sedation
- Patients do not always respond predictability
- Retrograde amnesia means patients anxiety isn’t cured
- Not guaranteed that treatment will be possible
- At the second visit patient may think they were asleep in the last visit
- Increased risk of medical complications
- Oral access may be compromised
What are the stages of intravenous sedation
- Pre assessment (separate visit)
- Pre op checks
- Pre op preparation for you and patient
- IV access
- Sedation
- Clinical procedure
- Recovery
What do we need to be monitoring during the clinical procedure under sedation
- BP
- Heart rate
- O2 saturation
What do the pre op checks include
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
What are the baseline observations we record during pre op checks
- General appearance
- Blood pressure
- Pulse
- Respiratory rate and oxygen saturation
What pre op preparation do you need to do
- Do you have all the equipment required to complete the procedure
- Are you competent enough to do the procedure
- Are the relevant investigation available
- Have you planned for any complications
Can a patient consent once they have had the sedation drug
no
What pre op prep do we need from the patient
- Pre op checks are within acceptable limits
- Patients has fasted as appropriate
- Topical skin anaesthesia if required
- Does pt need a toilet break
- Is pt aware of what is planned for the session
If a pt is diabetic what else might we check pre op
Pre op blood glucose
What drugs do we use for sedation
Midazolam 5mg in 5ml
In regards to the drugs what do we need to prepare post op
- PPE
- Label syringes
- Check drug type, concentration and expiry date
- Draw up saline and midazolam into appropriately labelled syringes
At the LDI what is our preferred concentration of midazolam
1mg per ml
Where can we cannulate for IV sedation
- Antecubital fossa
- Dorsum of the hand
Name the 2 veins we tend to use for IV sedation
- Basilic vein
- Cephalic vein
Talk through the pathway of the basilica vein
- Ascends along the medial surface of the forearm near the elbow
- Changes to a position in front of the medial epicondyle where is is joined by the median cubital vein
- Runs along the medial margin of the biceps muscle to the middle of the upper arm
- Pierces the deep fascia to run alongside the brachial artery becoming the axillary artery