W12: Spectrum of Pain Control Flashcards
List all methods of the Spectrum of Pain and Anxiety Control. Point out which method should be involved every procedure.
Define/compare Anxiolysis, Sedation and Hypnosis
- Anxiolysis – “dissolving anxiety” - Anxiety affects pain perception therefore anxiolytics may be avaluable adjunct to pain control
- Sedation – “state of relaxation or sleepiness”
- Hypnosis – inducing sleep
These drugs are all CNS depressants and also cause muscle relaxation. Action is dose dependent
What is a ‘Phobia’, more specifically the symptoms/signs
Mental health diagnosis criteria
Describe a tool that can be used to measure a patients anxiety. What score indicates a possible phobia?
Questionnaire
ach item scored as follows:
Not anxious = 1
Slightly anxious = 2
Fairly anxious = 3
Very anxious = 4
Extremely anxious = 5
Total score is a sum of all five items, range 5 to 25: Cut off is 19 or above which indicates a highly dentally anxious patient, possibly dentally phobic
List some Basic Patient Psychological/Behavioural management techniques
- Relaxation
- Cognitive rehearsal
- Distraction
- Modelling (watch other person go through process)
- De-sensitization (one step at a time/appt.)
- Hypnosis
Describe the risks of Local Anaesthesia
- Overdose (CNS effect that usually manifests as seizures)
- Trauma (during the procedure (facial nerve palsy) or post-op (lip biting ect.))
- Psychogenic (syncope) - faint
- Incorrect technique (ex, trismus)
- Equipment failure (needle fracture)
List some common pre-medication options
Describe the top 3 pre medication Pharmacokinetics - include dosage
Describe the 4 levels of Sedation
What is Nitrous oxide?
Characteristics
Sweet smelling, non-irritant colourless gasm, Naturally occuring, Weak anaesthetic, Low blood gas solubility, Drug of Abuse,
List the 4 Effects of Inhalation Sedation
- Sedation (side effect)
- Anxiolysis (GOAL)
- Mood alteration
- Analgesia
Describe the MOA/Pharmacodynamics of N2O
Potency of a drug is measured by ‘Minimum Alveolar Concentration (MAC)’. Define.
Potency: Alveolar concentration needed to prevent movement in 50% of patients in response to pain
Example: Low potency (High MAC = low potency) - MAC Inversly proportinate to potency
N2O: Weak anaesthetic MAC = 104 (%)
List the indications for Nitrous Oxide sedation
List the contraindications of Nitrous Oxide sedation
How do you minimise N2O pollution
N2O and Intravenous Sedation are forms of conscious sedation. What is conscious sedation? - define.
List the indications for IV sedation
List the drugs commonly used for List the indications for IV sedation
List the actions of Benzodiazepines
What is the process of dosage for sedatives?
Inject slowly with pauses between increments…Titrated against patient response
What are the signs of sedation
What is Flumazeni?
Reversal agent for BDZ
* Must be available
* Improves short term recovery
* Elective and emergency use
What are the Signs of sedation?
List the Post-sedation instructions
What level of sedation is General Anaesthesia?
Patients are unaware of and unresponsive to painful stimuli
* Effects are on the Central Nervous System
List the Indications for GA
List the three Ideal Anaesthetic Drug properties
- Rapid Induction
- Level of anaesthesia can be adjusted
- Rapid Recovery
Only possible with inhaled anaesthetics
The anaesthesia is CONTROLLABLE
Describe the potency of general anaesthetics
- Potency related to lipid solubility (↑lipid solubility = ↑potency)
- Potency expressed as the MAC value (inverse relationship) -
The Minimum alveolar concentration required to abolish a response to surgical incision in 50% of patients. related to…
Lipid solubility expressed as** oil:gas partition coefficient**
Describe the MOA of General anaesthetics including the sites of action
List the signs/action of General anaesthetics
- Unconsciousness
- Loss of reflexes (muscle relaxation)
- Analgesia
- Amnesia
Possible unwanted effects…
* ↓cardiac contractility→cardiovascular depression
* May cause ventricular extrasystoles (↑sensitivity to Adr)
* Respiratory depression (except N2O) and↑arterial CO2
What is a mallampati score used for?
Measure airway in order to fit aid for sedation
What is involved in a GA procedure (steps)
When the anaesthetic enters the body, where does it travel?
Injected Anaesthetics cross the Blood-brain barrier
Concentration of the anaesthetic in the brain closely approximates arterial concentration
Inhaled anaesthetics the anaesthetic moves from the alveoli to the bloodstream
Concentrations of the alveolar anaesthetic and the arterial anaesthetic approach equilibrium (dependent on the blood:gas partition coefficient)
The rate of equilibrium is dependent on the blood:gas partition coefficient. The ____ the solubility in blood, the faster the equilibrium is reached (onset) and the ____ it leaves the blood (recovery).
The rate of equilibrium is dependent on the blood:gas partition coefficient. The lower the solubility in blood, the faster the equilibrium is reached (onset) and the faster it leaves the blood (recovery)
What is the inverse indicator of anesthetic gas potency?
Minimum alveolar concentration (MAC)
What does the Blood:Gas partition co-efficient and Oil: gas partition co-efficient represent?
What classification represents an Estimation of medical risk to patients undergoing surgical procedure. List the levels
ASA Classification
List the advantages and disadvantages of Oral Premedication
List the advantages and disadvantages of Nitrous Oxide Sedation.
List the advantages and disadvantages of Intravenous Sedation
List the advantages and disadvantages of General Anaesthesia
