Special care and Conscious sedation

Question 1

What are some congenital/genetic movement disorders ?

Answer 1

• Muscular dystrophy
• Cerebral palsy
• Multiple sclerosis
• Parkinson’s disease
• Huntingdons Chorea

Question 2

What is an acquired movement disorder?

Answer 2

• Head injury

Question 3

What is the management of pts with involuntary movements?

Answer 3

• Assess their mental and physical status
• Do they have anxiety
• What is the pain experience

Question 4

What are some conscious sedation techniques?

Answer 4

• Inhalation sedation
• Intravenous
• Oral
• Transmucosal
  - Rectal
  - Intranasal
  - Sublingual

Question 5

What are some advantages of inhalation sedation?

Answer 5

• Useful for anxiety relief
• Rapid recovery
• Flexible duration

Question 6

What are some disadvantages of inhalation sedation?

Answer 6

• Keeping nasal hood in place
• Less muscle relaxation
• Coordination of nasal breathing when mouth open (some pts can’t do this i.e. kids or if they can’t understand you to explain it)

Question 7

What are the advantages for intravenous sedation?

Answer 7

• Good sedation achieved
• Less cooperation needed
• Muscle relaxation (helps reduce involuntary movement)

Question 8

What are some disadvantages of intravenous sedation?

Answer 8

• Baseline readings
• IV cannulation is required (can be hard to get this)
• Need to assess sedation level so no complications arise
• Behaviour during recovery needs to monitored
• Efficacy swallowing

Question 9

When performing a intravenous sedation what safety aspects do you need to consider?

Answer 9

• Swallowing
• Airway
• Liver
• Medication interactions
• ASA

Question 10

What are some advantages to Oral / Transmucosal sedation?

Answer 10

• Avoids cannulation initially (then good to cannulate so can top up the midazolam and also reverse if needed)
• Can make induction more pleasant
• Better cooperation
• Better future behaviour
• Sprays up their nose (easier than getting pt to drink it)
• Begins sedating in 7 mins

Question 11

What are some disadvantages for Oral / transmucosal sedation?

Answer 11

• Baseline readings
• Bitter taste/ stinging
• Lag time
• Untitrateable - conc of drug is very high due to placing in transmucosal
• Difficulty in monitoring level of sedation
• Behaviour in recovery

Question 12

How would you decide whether GA or sedation should be used?

Answer 12

• Safety concerns (Controlled airway with GA but difficult intubation)
• Co-operation
• Waiting lists and access to services
• Pain
• MH

Question 13

What is Remimazolam?

Answer 13

• Sedative drug currently undergoing dental clinical trials
• Benzodiazepine and methly ester molecule
• Rapid break down and onset
• Broken down by tissue esterase and hepatic carboxylesterase-1

Question 14

What is the distribution half life of midazolam compared to Remimazolam?

Answer 14

Midazolam = 4-18mins
Remimazolam = 0.5 -2 mins

Question 15

What is the elimination half-life of midazolam compared to remimazolam?

Answer 15

Midazolam = 1.5-2hrs
Remimazolam = 7-11mins