Sedation - Inhalation Flashcards
What are the indications for inhalation sedation use in adults and children? (6)
• Anxiety – mild/moderate (doesn’t work for severe anxiety)
• Needle phobia – used alongside needle desensitisation
• Gagging – gas held to reduce gag reflex
• Traumatic procedures – just unpleasant even if person isn’t anxious
• Prevent medical conditions worsening if they are aggravated by stress e.g. asthma
• Used for unaccompanied adults requiring sedation
What are the contraindications for inhalation sedation use in adults and children? (6)
• Common cold = blocked nose
• Tonsillar/adenoidal enlargement = natural mouth breathers – need to breathe through nose!
• Severe COPD
• First trimester of pregnancy
• Fear of “mask” / Claustrophobia
• Patients with limited ability to understand what is required of them during the procedure (i.e. small children under 7 or those with learning difficulties)
What colour is the quantiflex oxygen flow meter?
black
What colour is the nitrous oxide flow meter?
blue
what is the accuracy of the oxygen and nitrous oxide flow meters?
+/- 5%
What is the minimum % of oxygen that the oxygen flow meter can deliver?
30%
What are the functions of the 2 gas delivery hoses attached to the nasal hood?
One hose delivers fresh gases from machine
One hose delivers waste gas to scavenging system (waste nitrous oxide)
- Non return valve in expiratory limb prevents rebreathing expired gases
How many room air changes occur per hour and why are these carried out?
15 - to reduce the amount of nitrous oxide in the room air
Name all 14 safety features that are present when carrying out inhalation sedation and what they are used for.
• Pin index system = prevents the wrong cylinder being attached
• Diameter index system = prevents cross connection of piping
• Minimum oxygen delivery = 30%
• Oxygen fail safe = operates when oxygen pressure < 40 psi
• Air entrainment valve - if gases fail, valve opens allows room air into circuit
• Oxygen flush button - flushes O2 35 l/min. (fast flowing)
• Oxygen monitor
• Reservoir bag - helps to monitor respiration
• Colour coding = ensure the tanks aren’t attached to the wrong tubes.
• Scavenging system = ensure nirous oxide not breathed into the atmosphere
• Oxygen & nitrous oxide pressure dials
• Pressure reducing valves
• One way expiratory valve - prevents rebreathing expired gases
• Quick fit connection for positive pressure oxygen delivery
What are the advantages of using inhalation sedation? (10)
• Rapid onset (2-3 mins)
• Rapid peak action (3-5 mins)
• Depth altered either way (increase or decrease)
• Flexible duration – can use as required
• Rapid recovery
• No injection (for the sedation but obviously LA still required depending on the procedure)
• Few side effects to patient
• Drug not metabolised – just breathe it out
• Some analgesia (though better for iscaemic than inflammatory pain) still nee LA.
• No amnesia – can remember the whole procedure = positive experience and might not need sedation next time
What are the disadvantages of using inhalation sedation? (8)
• Equipment expensive
• Gases expensive
• Space occupying equipment = large
• Not potent – only provides a little bit of sedation, px has to be willing and only mild/moderately anxious
• Requires ability to breathe through nose
• Chronic exposure risk – theoretical risk (eliminated by scavenger methods) to environment and staff.
• Staff addiction
• Difficult to accurately determine actual dose – can be leakage
How do we know the patient is sedated enough? (17)
- Patient relaxed/comfortable: floaty/daydreaming/detached feeling (mental &physical)
- Patient awake and able to interact
- Reduced blink rate
- Laryngeal reflexes unaffected
- Vital signs unaffected
- Gag reflex reduced
- Mouth should be able to open on request
- Decreased reaction to painful stimuli
- Decrease in spontaneous movements
- Verbal contact maintained
- Lessened awareness of pain
- Paraesthesia – lips, fingers, toes, legs, tongue (tingling, pins&needles)
- Lethargy
- Euphoria
- Warmth (take excess clothing off)
- Altered awareness of passage of time
- Small controllable “fit of the giggles”
What are the signs of over sedation? (9)
- Mouth closing – repeatedly
- Spontaneous mouth breathing
- Nausea/vomiting
- Irrational and sluggish responses
- Decreased cooperation
- Incoherent speech
- Uncontrolled laughter, tears
- Patient say they no longer enjoying the effects
- Loss of consciousness
What pre-op instructions do we give patients before the sedation appointment? (8)
• Have a light meal before appointment (not directly before)
• 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
Describe the way in which we would provide the sedative during inhalation sedation. (5)
set mixture dial to 100% O2 ( flow to 5-6l per minute) and allow px to settle in dental chair
ensure px settled and comfortable with hood before proceeding – breathe only oxygen for about 1 minute
Reduce O2 by 10%
Wait 1 minute and repeat until reaches 80%
After O2 reaches 80%, reduce by 5% per minute until adequate sedation is reached.
