Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 8 > Special Care > Flashcards

Special Care Flashcards

Topics covered: Conscious Sedation an GA in Dentistry

1
Q

What is conscious sedation?

A

A technique in which the use of a drug or drugs to produce a state of CNS depression to enable treatment to be carried out.

Verbal contact with the pt is maintained throughout the period of sedation.

The drugs and techniques used to provide the sedation should carry a margin of safety wide enough to render loss of consciousness unlikely.

Only those who are sedation trained can carry out sedation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 types of sedation?

A
  1. Minimal sedation
  2. Moderate sedation
  3. Deep sedation
  4. General anaesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are benzodiazepines?

A

A class of drugs that can be used as pre-medication, and for sedation.

The most commonly used anxiolytics.

These drugs act an affect the Central Nervous System.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List 4 examples of benzodiazepines.

A
  1. Diazepam
  2. Lorazepam
  3. Temazepam
  4. Midazolam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What drug is used to reverse the effects of benzodiazepines?

A

Flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical effects of benzodiazepines on the body? (8 marks)

A
  1. Anxiolytic
  2. Anticonvulsant
  3. Slight sedation
  4. Reduced attention
  5. Amnesia
  6. Intense sedation
  7. Muscle relaxant
  8. General anaesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 4 different types of conscious sedation?

A
  1. Inhalation sedation
  2. IV sedation
  3. Oral sedation
  4. Intranasal sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 5 indications for conscious sedation.

A
  1. Dental anxiety and phobia
  2. A need for prolonged or traumatic dental procedures
  3. Medical conditions potentially aggravated by stress
  4. Medical or behavioural conditions affecting the patient’s ability to cooperate
  5. Special care requirements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is required to be carried out, recorded and documented as part of the pre-conscious sedation assessment?

A
  1. Thorough medical, dental, social, anxiety, and sedation/GA history
    - MH - include both prescribed and non-prescribed drugs (including recreational or illicit drugs)
    - SH - living arrangements, caring responsibilities, available chaperone, occupation (ability to arrange time off work)
  2. Baseline measurements:
    - Blood pressure
    - BMI
    - Heart rate
    - Oxygen sats
  3. Airway assessment
    - potential airway difficulties
  4. ASA status
  5. Dental tx plan
  6. Anxiety assessment
    - any tools used
  7. The selected conscious sedation technique and justification
  8. Any individual pt requirements
  9. Provision of pre- and post-op written instructions, including advice given on fasting
  10. Written consent for sedation and dental tx.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 3 different methods can be used to assess airway risk during sedation?

A
  1. Mallampati score:
    - Class I and II = adequate access
    - Class III = moderate access
    - Class IV = difficult access
  2. STOPBANG
    - S = Snoring
    - T = Tired
    - O = Observed apnoeas
    - P = Pressure (hypertension)
    - B = BMI
    - A = Age
    - N = Neck circumference
    - G = Gender
  3. LEMON:
    - L = Look externally
    - E = Evaluate 3-3-2
    - M = Mallampati score
    - O = Obstruction or Obesity
    - N = Neck mobility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which pts require referral to secondary care facility for conscious sedation according to ASA physical status chart?

A

All ASA grade IV

AND

Many ASA grade III pts - some may be treated in primary care depending on the available facilities, knowledge, skills and experience, and on the current stability of the pts medical condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List 5 examples of non-pharmacological anxiety management techniques that may be considered as an alternative to using conscious sedation to manage anxiety.

A
  1. Cognitive Behaviour Therapy
  2. Distraction
  3. Guided Imagery
  4. Hypnosis
  5. Play therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why might it be dangerous for an individual to undergo sedation under the influence of cannabis?

A

As cannabis reduces respiratory rate

This can be dangerous as IV midazolam also reduces the respiratory rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should be checked as part of the pts SH?

A
  1. Caring responsibilities - including pets
  2. Potential escorts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What information is recorded as part of the patients airway assessment?

A
  1. Neck size
  2. Posture
  3. Mallampati score

NB - can also use STOPBANG or LEMON to assess airway risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 3 commonly used conscious sedation STANDARD techniques.

A
  1. Inhalation sedation on its own
  2. Intra-venous sedation with a single drug (midazolam) by a single route
  3. Oral sedation with a single drug by a single route - have to cannulate them as soon as the pt cooperates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What 2 drugs are used for inhalation sedation?

A

Nitrous Oxide and Oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name one essential requirement for inhalation sedation?

A

The patient must be able to breathe through the nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What effects does inhalation sedation have on the patient?

A
  1. Mild sedation
  2. Potent anxiolytic effects
  3. Analgesic effect
    - however, still requires LA
  4. Post hypnotic suggestion
    - pt may believe that the sedation is ineffective
  5. NO hangover effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

During inhalation sedation, how can post-hypnotic suggestion be overcome?

A

By using techniques such as the “Coloured air technique”.

By reassuring the pt that they are safe.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How would you describe Nitrous Oxide and what are some of its properties?

A
  1. Inhaled gas
  2. Sweet smelling
  3. Colourless
  4. Heavy
    - excess falls to the floor
  5. AKA laughing gas
  6. Rapid onset (3-5 mins)
  7. Crosses blood-brain barrier rapidly
  8. Elimination is also rapid
  9. No significant metabolism by kidneys or liver
    - relatively safe for pts that have liver or kidney disease
  10. Not stored in the tissues
  11. NO ‘hangover’ effect - no escort necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the trade name for 50:50 nitrous oxide and oxygen (gas and air)?

A

Entonox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List 3 signs of nitrous oxide overdose?

A
  1. Headache
  2. Nausea
  3. Vomiting
  • Note that all of these signs are as a result of diffusion hypoxia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can you reduce the effects of nitrous oxide during and after inhalation sedation?

A
  1. Reduce dose
  2. O2 flush after cessation of nitrous oxide - Administer 100% oxygen for 5 mins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the indications for inhalation sedation?

A
  1. Mild anxiety
  2. Needle phobia
    - depends on how severe the phobia is, note that the pt still requires LA
  3. Patient not suitable for IV/GA
  4. Straightforward dental treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What factors can make dental tx under inhalation sedation more difficult?

A
  1. The patient’s ability to cooperate:
    - Age
    - Learning disability
    - Cognitive impairment
    - Ability to tolerate mask
  2. Mask may impede access to anterior teeth.
27
Q

What are the contraindications to IHS?

A
  1. COPD or any respiratory disease
  2. Recent eye or ear surgery (recent = within the last 6 months)
  3. Mask intolerance
  4. Pregnancy* - once they’re in labour it is fine to use
  5. Vit B12 deficiency - must be corrected first
  6. Methotrexate interaction – commonly used for psoriasis, they must have a drug holiday - liaise with doctor to see if this is safe
  7. Chemotherapy interaction

Note - Generally safe and well tolerated

28
Q

What equipment is used for inhalation sedation?

A
  1. RA machine
  2. Gas cylinders and piped gases
  3. Scavenging
  4. Monitoring for staff
29
Q

For inhalation sedation, why must the scavenging be low down?

A

As nitrous oxide is a heavy gas that falls to the ground.

30
Q

What drug is commonly used for IV sedation?

A

Midazolam

31
Q

What are the pt requirements for IV sedation?

A
  1. Must get cannulated
  2. Must have an escort that can look after them and only them for 24 hours
  3. Must not drive, use machinery or household appliances, attempt to cook, be left unsupervised, sign any important documents, or go on social media.
  4. Must get driven or taxi home - no public transport.
32
Q

What are the indications for IV sedation:

A
  1. Dentally anxious/phobic pt
  2. Medically suitable
  3. Social history
  4. Unpleasant procedure.
33
Q

What are the contraindications for IV sedation?

A
  1. Needle phobia
  2. Medical reasons
  3. Social reasons
  4. Pregnancy
  5. Poor venous access
34
Q

What is the max dose of midazolam that you can administer to a pt during IV sedation?

A

7.5mg is the maximum dose.

**Although in DDH it is 10mg (2 ampuoles).

35
Q

List 3 factors that may alter the monitoring values during conscious sedation.

A
  1. Nail polish, gel/acrylic nails can affect pulse oximeter reading
  2. Finger tapping can affect pulse oximeter reading
  3. Pt holding breath can affect pulse oximeter reading
36
Q

List 4 signs of Midazolam overdose.

A
  1. Loss of protective reflexes
  2. Loss of consciousness
  3. Decreased respiration
  4. Decreased HR
37
Q

What classification of drug is flumazenil?

A

A benzodiazepine antagonist

38
Q

How do you manage a sedation medical emergency?

A

Manage as if there was no sedation involved in the first place before considering the sedation.

39
Q

List 6 benefits of IV sedation.

A
  1. Fast acting
  2. Dose can be adjusted
  3. Relaxing effect
  4. Usually avoids the need for GA
  5. Has fewer side effects than a GA
  6. Recovery quicker than GA - can usually go home within an hour of TX if you feel well enough.
40
Q

List 6 risks of IV sedation.

A
  1. Decreased resp rate
  2. Decreased BP
  3. Nausea or vomiting (uncommon)
  4. Bruise where the cannula was placed
  5. Unsteadiness
  6. Lack of judgement and memory up to 24 hours
41
Q

What is oral sedation?

A

A method of sedation that involves oral consumption of a sedative drug (usually midazolam) in drink form.

Less common technique than IV or IHS

NOT the same as a ‘pre-med’

Must still cannulate for safety – rescue/reversal!

42
Q

When is oral sedation most commonly used?

A

For needle phobic patients and pts that cannot follow the breathing technique of inhalation sedation.

43
Q

In basic steps describe the oral sedation procedure.

A
  1. Pt given 10mg (2 viles) of midazolam diluted in a drink (eg. squash)
  2. Pt monitored visually and mechanically
  3. Cannula placed
  4. Requires a 2-hour appointment as it can take time for the drug to have effect.
    - drug must be digested first before entering the bloodstream and reaching the brain
44
Q

Is pre-medication the same as oral sedation?

A

No, they are not the same thing.

45
Q

What is a pre-medication?

A

Pre-medication is NOT a sedation technique.

It can be used as an anti-anxiety agent.

As dentists we can prescribe a pre-med.

46
Q

What drug is commonly used as a pre-med and what is the typical regime?

A

Diazepam.

  • 5-10mg (by tablet or elixir)
  • 1 tablet last thing at night the evening before the appointment
  • 1 tablet in the morning 60-90 mins before the appointment
47
Q

List 3 drugs that interact with diazepam?

A
  1. Antibacterials
    - Isoniazid inhibits metabolism
    - Rifampicin increases metabolism
  2. Antivirals
    - Ritonavir
  3. PPIs
    - Omeprazole
48
Q

List 3 indications for pre-medication?

A
  1. Very anxious pts
  2. Pts when sedation is contraindicated:
    - Medical reasons - e.g. leukaemia
    - Inability to get venous access - IV sedation
    - Inability to breathe through nose - IHS
  3. To take the edge off before more complex and prolonged procedures
49
Q

List 3 contraindications to pre-medication?

A
  1. Hepatic impairment
    - diazepam broken down in the liver
  2. Renal impairment
    - diazepam excreted via the kidneys
  3. Pregnancy and Breast feeding
    - can cause neonatal withdrawal symptoms
50
Q

What must you be cautious about when prescribing diazepam as a pre-med?

A
  1. Avoid prolonged use
    - addictive
  2. Avoid abrupt withdrawal
    - will cause withdrawal symptoms
  3. Reduce dose for elderly/debilitated patients
  4. Use with caution in those with respiratory disease
    - causes respiratory depression
    - avoid in pts with myasthenia gravis
  5. Pt compliance
    - pt may not take diazepam at the right time
51
Q

What can be used as an alternative to diazepam for pre-medication?

A

Temazepam

52
Q

How does flumazenil work as a reversal agent for benzodiazepines?

A

It works by competitive inhibition as it has a higher affinity for the GABAa receptors.

53
Q

List some effects of benzodiazepines.

A
  1. Anxiolytic
  2. Anticonvulsant
  3. Sedation
  4. Amnesia
  5. Anaesthesia
  6. Muscle relaxation

Short term:
7. Drowsiness
8. Dizziness
9. Reduced concentration
10. Reduced coordination
11. Hypotension
12. Respiratory depression
13. Sexual fantasy

Long term:
14. Tolerance
15. Dependence
16. Withdrawal

54
Q

Which type of sedation are the amnesia effects most intense with?

A

IV sedation

55
Q

What can you do to help prevent anaesthesia during sedation?

A

Administer 1mg, wait 60 seconds, observe and repeat if necessary.

  • Observe their hands, feet and speech. This will indicate the level of sedation.
56
Q

What guidance documents should be followed in relation to sedation?

A
  1. The intercollegiate advisory committee for sedation in dentistry standards
  2. SDCEP Conscious sedation in Dentistry (Third edition)
57
Q

What techniques should be used to check the pts understanding?

A
  1. ‘Chunk and check’
  2. ‘Teach it back’
  3. ‘Take the blame’
58
Q

What is general anaesthesia?

A

A state of controlled unconsciousness affecting the whole body, so the patient does not move or feel pain, with loss of protected reflexes.

An anaesthetist uses a combination of medicines to allow medical procedures to be carried out, that would otherwise be intolerable to the pt.

Can be induced by a large dose of benzodiazepine (eg. Midazolam).

All GAs can only be administered in hospitals with intensive care facilities for support.

59
Q

What are the indications for GA?

A
  1. Lengthy or complex surgery
  2. Very anxious/dental phobic pts who are unable to tolerate /cooperate with Tx under other modalities - e.g. LA, oral, IV, or nitrous oxide sedation
  3. Pts with profound learning disabilities who are unable to tolerate/cooperate with tx under other modalities - e.g LA, oral, IV or nitrous oxide sedation
  4. Multiple extractions in multiple quadrants
  5. Severe trauma or acute dental infection
  6. Cases where nitrous oxide or IV sedation is contraindicated or inappropriate.
60
Q

What are the advantages of GA?

A
  1. Pt cooperation not required once pt is anaesthetised - require a degree before anaesthetised
  2. Pt unaware of the procedure taking place
  3. Significant amount of Tx can be carried out in one attendance
  4. May be able to co-ordinate interventions with other specialities
61
Q

What are the disadvantages of GA?

A
  1. Requires pre-op assessment - medical and dental
  2. Needs careful Tx planning / all work to be done in one visit
  3. Tx often has to be more radical to be done in one visit
  4. Open consent often needed as cannot change the Tx plan half way through or wake pt to discuss. - e.g “EUA - examination under anaesthesia and dental Tx and dental treatment deemed appropriate” - note that pt may not be happy to give open consent
  5. Does not help pt get over their fear/ build confidence
  6. Cost
  7. Pre-op fasting and aftercare required
  8. Risk of morbidity and mortality of GA
62
Q

Common risks of GA?

A
  1. Headache
  2. Nausea
  3. Sickness
63
Q

Less common risks of GA?

A
  1. Hearts do funny things
  2. Allergic reaction
  3. Some people don’t fully recover
64
Q
A

Module 8 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions