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BDS4 CDS Sedation Symposium > inhalation sedation > Flashcards

inhalation sedation Flashcards

1
Q

indications for inhalation sedation (6)

A
  • Anxiety
    • Mild to moderate
  • Needle phobia
  • Gagging
  • Traumatic procedures
  • Medical conditions aggravated by stress
  • Unaccompanied adults requiring sedation
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2
Q

6 contraindications for inhalation sedation

A
  • Common cold
  • Tonsillar/adenoidal enlargement
  • Severe COPD reduction in air to them
  • First trimester of pregnancy no evidence, but just to avoid
  • Fear of ‘mask’/claustrophobia
  • Pts with limited ability to understand
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3
Q

equipment for inhalation sedation

A
  • Tanks (can have built into wall)
    • Blue N2O
    • Black with white topO2
  • Pressure reducing valves
  • Flow control meter
  • Reservoir bag
  • Gas delivery hoses
  • Nasal hood
  • Waste gas scavenging system
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4
Q

components of dial on IS machine

A

Quantiflex Oxygen flow meter (not blue)

  • Measures flow rates of up to 10 l/min.
  • The reading is taken from equator(middle) of ball.
  • Accuracy +/- 5%

Mixture control dial

  • O2 : N2O
  • Impossible to deliver less than 30% O2
    • Safety feature, only 21% in air
  • If O2 runs out, machine switches off

Nitrous oxide flow is blue

Air entrainment valve - if gases fail, valve opens allows room air into circuit

Oxygen flush button

  • flushes O2 35 l/min.
  • For emergency use only!
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5
Q

reservoir bag

A
  • 2 or 3 litre bag – rubber or silicone
    • Smaller bag available for children
  • The bag should move visibly with each inspiration and expiration
  • Must not collapse
  • Helps to monitor respiration
    • Can see if pt going into hyperventilation – doesn’t move much

Get them to breathe normally 12-16 breaths/min

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6
Q

gas delivery hoses

A
  • 2.5 cm diameter, corrugated hoses
  • Universal joints to fit different machines
  • One hose delivers fresh gases from machine
  • One hose delivers waste gas to scavenging system
  • Non return valve in expiratory limb prevents rebreathing expired gases
  • Single use breathing circuits
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7
Q

nasal mask/hood

A
  • Various sizes
  • Should form seal around pts nose
  • Two connections to breathing circuit
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8
Q

scavenging system

A
  • Active scavenging of waste gases: small negative pressure
  • Changing surgery air reduces nitrous oxide levels – 15 changes of room air per hour
  • Watch for patient mouth breathing.
    • Check mask seal to reduce contamination
    • Get them to practice at home
    • Use of rubber dam will decrease likelihood of mouth breathing
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9
Q

14 safety features of inhalation sedation equipment

A
  • Colour coding
  • Pin index system
    • prevents the wrong cylinder being attached on top of colour coding
  • Diameter index system
    • prevents cross connection of piping
  • Minimum oxygen delivery 30%
  • Oxygen fail safe
    • operates when oxygen pressure < 40 psi
  • Air entrainment valve
  • Oxygen flush button
  • Oxygen monitor
  • Reservoir bag
  • Scavenging system
  • Oxygen and nitrous oxide pressure dials
    • 2 tanks on each side, have full spare one behind one in use
      • Always have a full unopened tank of O2 for each pt
  • Pressure reducing valve
  • One way expiratory valve
  • Quick fit connection for positive pressure oxygen delivery
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10
Q

10 safety features of inhalation sedation

A
  • Rapid onset (2-3 mins)
  • Rapid peak action (3-5 mins)
  • Depth altered either way
  • Flexible duration
  • Rapid recovery
  • No injection (for the sedation but LA still required depending on the procedure)
  • Few side effects to patient
  • Drug not metabolised (unlike IV drugs, quicker)
  • Some analgesia (though better for ischaemic than inflammatory pain, can help with needle scratch)
  • No amnesia
    • Good for aiding anxiety as good experience more likely to redo
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11
Q

8 disadvantages of inhalation sedation

A
  • Equipment expensive
  • Gases expensive
  • Space occupying equipment
  • Not potent (only mild-moderate anxiety, need pt cooperation)
  • Requires ability to breathe through nose
  • Chronic exposure risk?
    • Scavenger system in place to minimise
  • Staff addiction
  • Difficulty to accurately determine actual dose
    • Leakage, movement etc
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12
Q

10 pt signs of adequate sedation

A
  • Patient relaxed/comfortable
    • Dreamy, floaty, daydreaming, heavy, tingling
  • Patient awake
  • Reduced blink rate
  • Laryngeal reflexes unaffected
  • Vital signs unaffected
  • Gag reflex reduced
  • Mouth open on request
  • Decreased reaction to painful stimuli
  • Decrease in spontaneous movements
  • Verbal contact maintained
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13
Q

10 symptoms of adequate sedation

A
  • Mental and physical relaxation
  • Lessened awareness of pain
  • Paraesthesia – lips, fingers, toes, legs, tongue (tingling)
  • Lethargy/”a few pints”, “why your mum is less grumpy after a glass of wine”
  • Euphoria
  • Detachment ‘floating feeling’
  • Warmth
  • Altered awareness of passage of time
  • Dreaming
  • Small controllable “fit of the giggles”
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14
Q

9 signs/symptoms of oversedation

A
  • Mouth closing – repeatedly
  • Spontaneous mouth breathing
  • Nausea/vomiting
  • Irrational and sluggish responses
  • Decreased cooperation
  • Incoherent speech
  • Uncontrolled laughter, tears
  • Patient no longer enjoying the effects
  • Loss of consciousness
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15
Q

8 things to tell pt pre-op

A
  • Have a light meal before appointment
  • Take routine medicines as usual
  • Children accompanied by a competent adult
  • Adults accompanied at their first sedation appt. afterwards may then attend alone
  • Do not drink alcohol on day of appointment
  • Wear sensible clothing
  • Arrange care of children during and after your appointment
  • Plan to remain in clinic for up to 30 minutes after treatment
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16
Q

Inhalation sedation procedure

A
  • Set up the machine
  • Select nasal hood (record size in notes)
  • Connect to hoses
  • Set mixture dial to 100% O2
  • Settle patient in dental chair
  • Reinforce explanations of procedure
    • Stay nice and calm and breathe through nose at all times
  • Set flow to 5-6l per minute
  • Position hood on the patient’s nose
  • Encourage nasal breathing
  • Check reservoir bag movements on 100% O2
    • Should be small, regular movements – mimic lungs
    • Too small movements = check seal & look for mouth breathing +/- decrease the flow
    • movement too great = increase the flow rate
  • Patient to be comfortable with hood before proceeding – about 1 minute
  • Reduce O2 by 10%
  • Ask patient to signal when begin to feel different
    • Wait 1 minute and repeat
  • After O2 reaches 80%, reduce by 5% per minute
  • Stop titration when patient ready for treatment
17
Q

what to do whilst carrying out tx under IS

A
  • Constant reassurance & hypnotic suggestion
    • Visualise
      • Waves going in and out
      • a place that makes them feel calm – discuss before
  • Monitor the patient during dental treatment nurse will too
    • If patient over-sedated increase O2 in 5-10% increments until satisfactory sedation
    • If under-sedated decrease O2 in 5% increments until satisfactory sedation
18
Q

recovery for inhalation sedation

A
  • Gradually increase O2 by 10-20% per minute until 100% or can turn straight to 100%
  • Administer 100% O2 for 2-3 minutes to prevent diffusion hypoxia
  • Diffusion hypoxia can occur with the administration of inadequate amounts of oxygen during or immediately after N2O anesthesia.
    • The Fink effect, also known as “diffusion anoxia,” “diffusion hypoxia,” or the “third gas effect,” is a factor that influences the partial pressure of oxygen (PO2) within the alveolus- this is really a theoretical risk, it does not happen as our equipment always delivers enough O2
  • Remove hood and turn gas flow off
  • Return patient to upright slowly, give praise and reassurance
    • Make sure they feel completely alright and normal before standing
19
Q

after inhalation sedation tx

A
  • Adult patients may leave unaccompanied at dentist’s discretion
  • Child patients (<16 years) must be accompanied by a competent adult

Prior to discharge, ask how patient felt procedure went – and listen!

Patients may feel shivery after I.S- reassure patient that this is common and passes quickly

BDS4 CDS Sedation Symposium (8 decks)

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