Inhalation sedation 2

Question 1

What equipment is for inhalation sedation?

Answer 1

Stand alone unit
Piped in system
Gas cylinders
Piping
4 cylinders- 2x in use and 2x full

Question 2

What colours are the gas cylinders and piping?

Answer 2

Oxygen is black and N2O is blue

Question 3

What are the components of the piped in system?

Answer 3

-MDM head
-Active scavenging

Question 4

What is the function of active scavenging?

Answer 4

For safety - helps reduce trace amounts of N2O from atmosphere

Question 5

What are the features of a nasal mask?

Answer 5

They are:
-single use
-some are autoclaveable

Question 6

What do you need to consider when choosing size of mask?

Answer 6

That you can achieve a good seal

Question 7

What is the technique for inhalation sedation?

Answer 7

Standard techniques as per IACSD
Nitrous oxide with oxygen

Question 8

Describe how equipment is checked?

Answer 8

Regular service every 6-12 months
Daily checks before use
Check tubing, and resevoir bag for rips, leaks, damage, tears

Question 9

How is pt prepared for inhalation sedation?

Answer 9

Good pt selection is essential
let pt see amsk and try it on
consent before appt- need consent for sedation and dental treatment, if pt is a child-need adult with parental responsibility
Written info needs to be given in advance- info about sedation, preo op and post op info

Question 10

Describe what is included in pre-sedation assessment?

Answer 10

-Full MH
-Prescribed and non prescribed drugs
-Any allergies
-Airway problems?
BMI
-ASA status
-Dental history
-Anxiety assessment
-Sedation and GA history
-SH- transport, escort, dependants

Question 11

What are the pre-op instructions?

Answer 11

-Light meal 2hrs before appt
-No alcohol 24 hrs prior
-If pt is child- need responsible adult to accompany- with no other children
-Transport home- in a car or taxi
-Avoid bikes, trampolines, machinery, driving,
-Children(under 16) to be supervised by adult- ADULTS-undergoing inhalation sedation with N20/oxygen do not require an escort unless they have mobility issues or other indications

Question 12

How to undergo dental treatment under inhalation sedation?

Answer 12

-Still need LA
-Good rapport
-Explain tx to pt
-stop signals
-gain trust
-consider into appt first/ appt with minimal tx

Question 13

What are the pre op checks?

Answer 13

-Preop checks:
STAFF- sedationist, sedation trained nurse and another dental nurse
EQUIPMENT- Emergency and sedation

Preop pt checks:
Pt identification
planned dental procedure
Written consent
patent nose- no cold, cold, URTI
last emal/ drink / alcohol
MH
Pregnancy
Responsible adult
Transport arrangements

Question 14

Signs of adequate inhalation sedation

Answer 14

Relaxed, warm feeling, tingling, lethargic/tired, dreamy, reduced gag reflex, STILL respond to questions, vital signs and reflexes intact

Question 15

Process of administering inhalation sedation?

Answer 15

Fit appropriate size nasal mask
Make the pt comfortable
Place them semi supine or supine
100% O2 flow
Adjust flow rate 4-6l/min
Reservoir bag should expand with each breath
After a few mins. begin to titrate N2O in 10% increments per minute
When you get to above 30% N2O then give in 5% increments
Encourage pt to breathe through nose and minimise talking
once happy with level of sedation, start dental tx

Question 16

Ineffective technique:

Answer 16

Nasal obstruction
mouth breathing (talking)
ineffective seal around nasal mask
pt resisting effects
too anxious
faulty equipment

Question 17

How to monitor pts while sedated?

Answer 17

Monitor the pts clinical signs:
-level of consciousness/ level of sedation
airway patency
respiration rate and depth

(also non invasive bp checking may be indicated- eg in pts with CVD

Question 18

Oversedation

Answer 18

pt may squint, complain of headache or nausea
How to deal with this:
Reduce N2O by 5-10%
reassure pt
monitor pt
if they recover then can continue
if severe then postpone tx

Question 19

Recovery:

Answer 19

Once tx is complee reduce N2O to zero
Give 100% O2
Breathe for 3 mins
Remove nasal mask
Sit pt upright
Check they are not dizzy or nauseous
Check they can walk steadily
Post op instructions

Question 20

Discharge

Answer 20

Discharge once happy pt has recovered
Give post op instructions
Record procedure

Question 21

What to record for sedation procedure:

Answer 21

Dose, route, time(S) of adminstration of N2O
Details of cloinical monitoring (pre-op, after drug titration, intra op and post op plus any significant events)
Personnel present in surgery
Dental tx provided
pt recation, sedation score and success of sedation
Time of discharge