W12: Spectrum of Pain Control

Question 1

List all methods of the Spectrum of Pain and Anxiety Control. Point out which method should be involved every procedure.

Answer 1

Question 2

Define/compare Anxiolysis, Sedation and Hypnosis

Answer 2

• 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

Question 3

What is a ‘Phobia’, more specifically the symptoms/signs

Answer 3

Mental health diagnosis criteria

Question 4

Describe a tool that can be used to measure a patients anxiety. What score indicates a possible phobia?

Answer 4

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

Can be counter productive and induce anxiety

Question 5

List some Basic Patient Psychological/Behavioural management techniques

Answer 5

• Relaxation
• Cognitive rehearsal
• Distraction
• Modelling (watch other person go through process)
• De-sensitization (one step at a time/appt.)
• Hypnosis

Question 6

Describe the risks of Local Anaesthesia

Answer 6

• 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)

Question 7

List some common pre-medication options

Answer 7

Question 8

Describe the top 3 pre medication Pharmacokinetics - include dosage

Answer 8

Question 9

Describe the 4 levels of Sedation

Answer 9

Question 10

What is Nitrous oxide?

Characteristics

Answer 10

Sweet smelling, non-irritant colourless gasm, Naturally occuring, Weak anaesthetic, Low blood gas solubility, Drug of Abuse,

Question 11

List the 4 Effects of Inhalation Sedation

Answer 11

• Sedation (side effect)
• Anxiolysis (GOAL)
• Mood alteration
• Analgesia

Question 12

Describe the MOA/Pharmacodynamics of N2O

Answer 12

Question 13

Potency of a drug is measured by ‘Minimum Alveolar Concentration (MAC)’. Define.

Answer 13

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 (%)

Question 14

List the indications for Nitrous Oxide sedation

Answer 14

Question 15

List the contraindications of Nitrous Oxide sedation

Answer 15

Question 16

How do you minimise N2O pollution

Answer 16

Question 17

N2O and Intravenous Sedation are forms of conscious sedation. What is conscious sedation? - define.

Answer 17

Question 18

List the indications for IV sedation

Answer 18

Question 19

List the drugs commonly used for List the indications for IV sedation

Answer 19

Question 20

List the actions of Benzodiazepines

Answer 20

Therefore close monitoring is important - O2 saturation, pulse, BP, breath

Question 21

What is the process of dosage for sedatives?

Answer 21

Inject slowly with pauses between increments…Titrated against patient response

Question 22

What are the signs of sedation

Answer 22

Question 23

What is Flumazeni?

Answer 23

Reversal agent for BDZ
* Must be available
* Improves short term recovery
* Elective and emergency use

Question 24

What are the Signs of sedation?

Answer 24

Question 25

List the Post-sedation instructions

Answer 25

Question 26

What level of sedation is General Anaesthesia?

Answer 26

Patients are **unaware** of and **unresponsive** to painful stimuli * Effects are on the Central Nervous System

Question 27

List the Indications for GA

Answer 27

Question 28

List the three Ideal Anaesthetic Drug properties

Answer 28

* Rapid Induction * Level of anaesthesia can be adjusted * Rapid Recovery *Only possible with inhaled anaesthetics* The anaesthesia is **CONTROLLABLE**

Question 29

Describe the potency of general anaesthetics

Answer 29

* 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**

Question 30

Describe the MOA of General anaesthetics including the sites of action

Answer 30

Question 31

List the signs/action of General anaesthetics

Answer 31

* 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

Question 32

What is a mallampati score used for?

Answer 32

Measure airway in order to fit aid for sedation

Question 33

What is involved in a GA procedure (steps)

Answer 33

Question 34

When the anaesthetic enters the body, where does it travel?

Answer 34

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)

Question 35

The rate of equilibrium is dependent on the **blood:gas partition coefficien**t. The ____ the solubility in blood, the faster the equilibrium is reached (onset) and the ____ it leaves the blood (recovery).

Answer 35

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)

Question 36

What is the **inverse indicator of anesthetic gas potency**?

Answer 36

**Minimum alveolar concentration (MAC)**

Question 37

What does the **Blood:Gas partition co-efficient** and **Oil: gas partition co-efficient** represent?

Answer 37

Question 38

What classification represents an **Estimation of medical risk to patients undergoing surgical procedure**. List the levels

Answer 38

ASA Classification

Question 39

List the advantages and disadvantages of **Oral Premedication**

Answer 39

Question 40

List the advantages and disadvantages of **Nitrous Oxide Sedation**.

Answer 40

Question 41

List the advantages and disadvantages of **Intravenous Sedation**

Answer 41

Question 42

List the advantages and disadvantages of **General Anaesthesia**

Answer 42