sedation technique Flashcards
advantages of IV sedation
safer than GA when performed correctly
outpatient procedure
reduction in anxiety
patient forget the unpleasant experience
disadvantages of IV sedation
• Patients do not always respond predictably
• Retrograde amnesia
• Not always guaranteed treatment is possible
• At second visits patients can think they were asleep
• Increased risk of medical complications
Oral access may be compromised
stages of IV care
pre sedation assessment
pre op check
post op check
iv access
sedation
clinical procedure
recovery
what pre operative checks do we need to do
• Escort present and are they appropriate to take care of the patient
• Medical history changes
• Consent appropriate and up to date
• Baseline observations-
• General appearance
• BP
• Pulse
Respiratory rate + oxygen saturation
what are some pre operative checked that are vital
equipment check
competency check
stats
plan for complications
consent
what are patient checks we need to carry out
• Pre op checks are in acceptable limits
• Fasted appropriately- small meal or sugary drink before
• Topical applied if needed
• Toilet break
They know the plan for this session - cannot consent post sedation
describe midazolam
benzodiazepine drug
in dentistry we use 1mg per 1ml but different concs are available
what sites can we use for IV access
antecubital fossa
sorsum of the hand
if we are using the antecubital fossa what veins do we use
basilic vein
cephalic vein
describe the path of the basilica vein
ascends on the medial surface of the forearm
vein changes position in front of the medial epicondyle and then joined by cubital been
pierces the deep fascia to run alongside the brachial artery
describe the path of the cephalic vein
Ascends on the front of the lateral side of the forearm to the front of the elbow
Where it communicates with the basilic vein through the median cubital vein
Then ascends along the lateral surface of the biceps muscle to the lower border of the pectoralis major muscle
Where it pierce the clavipectoral fascia and pass beneath the clavicle.
It then terminates in the axillary vein
advantages of the antecubital fossa
Less vulnerable to vasoconstriction
Usually bigger and well tethered
May be less painful than the dorsum of the hand
disadvantages of the antecubital fossa
Veins may be less visible- with increased BMI
Brachial artery and median nerve are medial to the biceps tendon
May be less obvious if the cannula is incorrectly placed
what veins do we use in the dorsum of the hand
cephalic vein
dorsal venous network
advantages of the dorsum of the hand
Veins tend to be visible
Not likely to damage important vessels
disadvantages of the dorsum of the hand
Vulnerable to vasoconstriction
Usually smaller and more mobile veins
Tends to be more painful
what equipment do we need for IV conscious sedation
• Tourniquet
• 22g cannula
• Timer
• Midazolam
• Normal saline
• Gauze
Skin prep
what if we struggle finding a vein
tourniquet
hand in warm water
NO can be used as it is a vasodilation
what consideration do we need to use for NO to help locate veins
we need to wait for the NO to fade off as we should not mix midazolam and NO sedation
describe how we know the cannula is placed correctly
• No bruising/swelling
• Flush cannula with saline at least 2 mls
• If swelling or pain/resistant cannula may be incorrectly placed
Adjust if necessary
technique to sedate the patient
• Check syringe is firmly attached
• Start timer and give 1mg of midazolam in 1ml in 10-15 seconds
• Observe effect
• Give additional 1mg increments as required
• Wait 1 minute between increments
• Be patient, converse with the patient
If there is no effect check the cannula site
describe clinical effect of midazolam
• Delayed response to questions
• Slurred speech
• Relaxed demeanour
• Comfortable
• Patient might have an itchy nose or cross legs
• EVEs sign- patient cannot find nose and touch it
Verrills sign- partially closed pupils
how do we manage a sedated patient
positive dialogue
speak firmly
describe the recovery stage
do not reverse the drug
• Leave a cannula in place until ready for discharge
• Usually minim of 60 minutes after the last dose of midazolam
• Post op verbal and written instructions
Ensure patient can stand and walk
