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Year 4, Sem 2 > CF- Reith Special Needs > Flashcards

CF- Reith Special Needs Flashcards

1
Q

What are characteristics of ideal sedative agent?

A
  • Predictable in its Action
  • Painless in Administration
  • Immediate Onset
  • Entirely Pleasant to the Patient
  • No side effects
  • Immediate Recovery on Demand
  • Amnesia for the Duration
  • Profound Anxiolysis
  • Inexpensive
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2
Q

What are characteristics of N2O?

A
  • Sweet smelling, non irritant colourless gas
  • Natually occurring
  • Produces analgesia
  • Weak anaesthetic
  • Low blood gas solubility
  • Drug of abuse
  • Engine performance enhancer
  • Greenhouse gas
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3
Q

What are effects of inhalation sedation?

A
  • Sedation
  • Anxiolysis
  • Mood alteration
  • Euphoria
  • Analgesia
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4
Q

What is MAC?

A

Alveolar concentration needed to prevent movement in 50% of pts in response to pain (High MAC = low potency)

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5
Q

What are indications for N2O?

A
  • Anxious adults and children
  • Needle phobia
  • Gag reflex
  • Medically compromised
  • Unpleasant procedure (alternative to GA)
  • To improve LA success
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6
Q

What are contraindications for N2O?

A
  • Uncooperative/uncommunicative pt
  • Blocked airway
  • Serious pulmonary disease
  • Recent eye/ear/GI surgery
  • Recent head injury
  • First trimester of pregnancy
  • Serious psychological disorders
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7
Q

What are advantages of inhaled sedation?

A
  • Non-invasive
  • Drug level easily altered or disocontinued
  • Excreted via lungs with rapid recovery
  • Some analgesia
  • Gag reflex obtunded
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8
Q

What are disadvantages of N2O?

A
  • Technique dependent
  • Requires pyscholoigcal support
  • Variable amnesia
  • Route of administration close to operating site
  • Nitrous oxide pollution
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9
Q

How to minimise N2O pollution?

A
  • Active scavenging systems
  • Good ventilation
  • Floor level extractor fans
  • Good mask seal
  • Minimise pt talking
  • Use of rubber dam
  • Equipment readily checked
  • 100% O2 at end of procedure
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10
Q

How to monitor pt having N2O?

A
  • Assess level of consciousness (verbal response)
  • Airway patency
  • Respiration
  • Skin colour
  • Capillary refill
  • Pulse rate
  • Rhythm and volume
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11
Q

How to administer N2O?

A
  • 10% N2O for 1 min, then 20%
  • Further increments of 5% per min until adequately sedated
  • Averalge flow 5-7L/min
  • Usualy dose range 20-50% N2O
  • 100% O2 at end of procedure
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12
Q

What are signs of N2O sedation?

A
  • Pt awake with verbal communication
  • Pt relaxed and comfortable
  • Pulse, BP, RR WNL
  • Reduced blink rate
  • Mouth remains open on request
  • Protective reflexes are maintained (cough)
  • Gag reflex reduced
  • Decreased response to painful stimuli
  • General decrease in movements
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13
Q

What are symptoms of N2O sedation?

A
  • Relaxed, comfortable
  • Pain severity decreased
  • Paraesthesua/tingling in fingers/toes
  • Lethargy
  • Euphoria
  • Detachment
  • Warmth (vasodilation)
  • Indifference to passage of time
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14
Q

What are features of oversedation?

A

Persistent mouth closing
Spontaneous mouth breathing
Pt complains of unpleasant feelings
Lack of cooperation
Nausea/vomitting

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15
Q

What to check before discharge of pt having N2O?

A
  • Assess fitness to leave
  • Ask if they feel okay to leave
  • Walk and balance unaided
  • Written post-sedation instructions
  • Clinical records
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16
Q

What are indications for IV sedation?

A
  • Anxiety
  • Conditions made worse by anxiety (angina, asthma)
  • To prevent dental phobia
  • To avoid GA
  • Special needs
17
Q

What are advantages of IV sedation?

A
  • Rapid sedation
  • Good pt cooperation
  • Amnesia
18
Q

What are disadvantages of IV sedation?

A
  • Respiratory depression
  • Disinhibition effects
  • Post operative supervision required
19
Q

What are referral criteria for IV sedation?

A
  • ASA I or II
  • Good airway
  • No allergies to benzos
  • BMI <40
  • Age >16 (caution > 65)
  • Suitable escort and carer available
  • Able to consent
  • Able to communicate during tx
  • Not pregnacnt
  • No movement disorders that would compromise safe dental tx
  • Able to tolerate cannulation
  • Recreational drug use may influence tx
20
Q

Why is midazolam a common IV and oral sedation agent? What is the reversal agent?

A
  • Wide safety margin
  • Reversal agent- Flumazenil
21
Q

What are actions of benzos?

A
  • Anxiolytic
  • Sedative
  • Amnesia
  • Central muscle relaxant
  • Respiratory depression
  • Anticonvulsant
  • Disinhibition
22
Q

What are post sedation instructions for IV sedation?

A
  • No driving
  • Escort for 8 hours
  • Not to sign important documents
  • Not to use machinery
  • No alcohol
  • Tx information

Year 4, Sem 2 (38 decks)

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