Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

DS4101 > W11 - Sedation/GA in Kids - Mistry > Flashcards

W11 - Sedation/GA in Kids - Mistry Flashcards

1
Q

4 Sedation techniques available for dental treatment

A
  1. Nitrous oxide
  2. GA
  3. Oral sedation
  4. IV sedation
  5. Combo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is RA?

A

Relative analgesia

Ex. Nitrous oxide

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

Features of NO (3)

A
  • Conscious sedation
  • Pt can breathe on their own
  • Anxiolytic and analgesic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Features of Stage 1 Plane 1 - NO (6)

A

Moderate sedation and analgesia

  • Increased pain threshold
  • Normal vitals
  • Reflexes unaffected
  • Feeling relaxed and less scared
  • Paraesthesia (tingling in fingers, lips)
  • Can communicate and cooperate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Features of Stage 1 Plane 2 - NO (feeling, reflexes) (7)

A

Dissociation sedation and analgesia

  • like plane 1 but further relaxation
  • Reduced blink rate
  • Pharyngeal reflex is reduced
  • Laryngeal reflex intact
  • “floating” euphoric sensation
  • Can maintain open mouth
  • Possibility of amnesia and time warp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do stage 1 plane 1 and 2 differ from each other in terms of reflex?

A

Both planes will remain with laryngeal reflex

  • Pharyngeal reflex is reduced in plane 2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What clinical tips can be done to help monitor pts dosage of Nitrous oxide?

A

No glasses - assess their eyes and blink rate

No bite block - ask if they can keep their mouth open (if not, has gone beyond plane 2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of Stage 1: Plane 3 - NO

A

Total analgesia (not advised for dental practice)

No longer relative analgesia

  • Pt may not be able to open mouth
  • May be sleepy/sweaty/nauseous
  • May not respond to words or pain
  • Reduced pharyngeal and laryngeal reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of stage 2 - NO (6)

A

Excitement or Delerium

  • Not advised for dental surgery
  • Excitement or struggling
  • Pharyngeal and laryngeal reflexes significantly reduced
  • Increased vitals (BP, HR, Resp)
  • Dilated pupils
  • Could have loss of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of stage 3 and stage 4 (NO)

A

Stage 3 - surgical anesthesia (GA)

Stage 4 - respiratory paralysis → death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Properties of N2O gas

A
  • Non irritating
  • Non flammable
  • Colourless
  • Sweet smelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What makes N2O have quick onset and recovery (2)

A

Gas is relatively insoluble in blood

Primary saturation of blood and brain takes 3-5 min (induction)

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

How does the body metabolise N2O

A

It doesnt

  • No biotransformation in body
  • Excreted unchanged via the lungs (99%) at a similar rate to absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Effects of N2O on CNS (2)

A
  • Acts directly on opioid receptors
  • Acts of RAS - controls emotions

Produces:

  1. Analagesia
  2. Euphoria
  3. Amnesia
  4. Anxiolytic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Physiological effect of N2O on the CVS (3)

A
  • No clinically significant difference to heart rate at therapeutic doses
  • Reduced heart rate of first stage could be due to peripheral vasodilation or anxiolytic effect
  • Peripheral vasodilation - flushing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Effects of N2O on resp

A

No direct effect

Non irritating

Caution with emphysema / COPD

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

Conditions to be mindful of with N2O

A

Emphysema

COPD

GIT (N2O can cause nausea)

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

Is N2O safe for pregnancy?

A

Yes generally

BUT

Passes readily through placenta

Avoid in first trimester (but not contraindicated)

20
Q

Indications for N2O (3)

A
  • Mild to mod anxiety (not severe)
  • Sensitive to gag reflex
  • Intolerance to long appointments
21
Q

Contra-indications for N2O (7)

A

Airway blockage (cold, obstructive passage)

Precooperative child (<3 yo)

Uncooperative / severe behavioural problems

Intellectually disabled

Psychiatric disorders

Conditions with trapped gas

Significant medically compromised patients

22
Q

What are some significant medically compromised scenarios where N2O is contraindicated?

A

Bleomycin chemotherapy - Lungs are fibrosed (contraindicated)

MTHFR Deficiency - metabolic disease assoc w/ hemocystinuria

Caution:

Complex cardiac conditions

Myasthenia gracis

MS

COPD

Severe asthma

23
Q

What pts are at risk for N2O induced bone marrow suppression, neurotoxicity or increased homocysteine levels

A
  • History of B12 or folate deficiency
  • Vegetarians
  • Pts on proton pump inhibitors or H2 blockers
  • MTHFR deficiency

Not contraindicated (except MTHFR) - just take caution

24
Q

Maximum percentage dose of N2O

A

50%

Though Mistry only goes up to 40%

25
Safety Features of N2O equipment
* Min oxygen flow of 3L/min and max flow of 10L/min N2O or minimum of 30% oxygen * Capacity for administration of 100% oxygen ("O2 Flush") * Automatic environemental air intake in event of gas flow supply failure * Serviced / checked routinely * Scavenging system for expired gases (that way not everyone in the room gets high) * One way valve (prevent rebreathing)
26
Requirements for N2O administration (6)
* Credentialed dentists * Administrator must be present at all times * Always have a chaperone * Advanced life support skills * Informed consent * Record details
27
N2O Technique steps (7)
Nasal mask placed Adjust flow rate Start with 100% oxygen Reservoir bag partially inflated but not full Titrate Constant monitoring Rubber dam and HVS
28
What is diffusion hypoxia and how can it be overcome
N2O diffuses out of blood and into alveoli rapidly * This _dilutes availble oxygen in the lungs_ Restore via the administration o**f 100% O2 for 3-5 minutes** after N2O termination * Give post op instructions and discharge
29
When do complications arise for N2O (3)
1. Over sedation 2. Lack of monitoring 3. Interaction with other meds (CNS depressants)
30
Adverse reactions of N2O (6)
* Nausea / vomiting * Dizziness * Hypoxia * Oversedation * Volume/pressure on trapped gas filled cavities * Bone marrow depression from chronic use (\>24h)
31
Occupational hazards of N2O
Prolonged exposure can lead to: **Interference with V B12 synthesis** Resulting in _haematopoietic and myeloneuropathic disturbances_ Ex. impaired RBC production and subsequent anemia, neurological disorders (paraesthesia, ataxia) **Teratogenicity** **Reduced fertility** **Spontaneous abortions**
32
Advantages of N2O (6)
Non invasive Mild analgesic Anxiolytic/sedative Minimal impact on reflexes Easily titrated Rapid onset/recovery
33
Disadvantages of N2O (6)
Requires coop with mask Mask interferes with procedure Needs continuous administration Occupational hazard Lack of potency Cost for practice
34
If pt is super anxious or stressed, will N2O work?
No - recommend GA
35
Describe the effectiveness of N2O paediatric dentistry
In anxious children, the use of N2O for the first few sessions leads to significantly reduced anxiety in following sessions, even without N2O
36
what is oral and IV sedation
* Form of **conscious sedation** * Minimally depressed level of consciousness (can still maintain airway and respond to touch and verbal command)
37
Contraindications of oral sedation
* Pts who are unable to take medication orally * Medical issues and interactions * Use precautions with kids \<6
38
Indications for IV sedation (2)
Anxious Invasive procedures of short duration Children 12+
39
Contraindications of IV sedation
Inability to tolerate IV access Medical issues and interactions Children \<6
40
Sedative agents (5)
Benzos (midazolam, diazepam/valium) Antihistamines Opioids Ketamine Barbituates
41
What is GA? Features? (3)
Induced state of unconsciousness * Accompanied by partial or complete loss of reflexes * Inability to maintain airway * Unresponsive to physical stimulation and verbal command
42
Objectives of GA (5)
* Reduce movement and reaction to treatment * Eliminate anxiety * Provide safe, efficient, effective care * Aid in tx of mentally, physically, medically compromised pt * Eliminate pain response
43
Indications for GA (6)
Very anxious Moderately-extremely uncoop Uncoop due to medical, physical, psycho disability Extensive surgery When prompt tx of acute condition is required (ex abscess threatening airway) Not responsive to behaviour management
44
Contraindications for GA
where medical issue risks outweigh the benefits
45
How should you manage pt if theyre going under GA? What is required?
Effort should be made to ensure that only one session is required * Need comprehensive workup (radiographs) * Comprehensive tx planning * Definitive tx (no GICs, should last)
46
Indications and contraindications of Oral sedation (3 and 3)
**Indications:** * To be used when parenteral routes are not preferred or not possible * Anxious * Coop needed for procedures of long duration **Contraindications:** * Unable to take meds orally * Medical issues and interactions * Careful with kids \<6

DS4101 (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions