complications

Question 1

what drug is used for intravenous sedation in dentistry and what group of drugs does it belong

Answer 1

midazolam
a benzodiazepine

Question 2

venospasm

Answer 2

dissapearing vein syndrome
veins collapse at attemped venepuncture - a protective mechanism by the body
associated with poorly visible veins

Question 3

extravascular injection

Answer 3

active drug placed into interstitial space
sees pain and swelling in the area and results in delayed absorption

Question 4

how can extravascular injection be avoided

Answer 4

good cannulation and a test dose of saline through the cannula prior to the drug

Question 5

intra arterial injection diagnosis

Answer 5

pain on venepuncture, red blood in cannula, pressure may see blood pouring from cannula, pain radiating distally from canula site, loss of colour/ warmth to limb, weakening pulse

Question 6

If canulating in antecubital fossa ragion where should you always go to avoid an intra arterial injection

Answer 6

always go lateral to bicep tendon to avoid brachial artery and median nerve

Question 7

extravasation

Answer 7

unintentional leakage of liquid from a vein into surrounding tissues

Question 8

haematoma

Answer 8

extravasation of blood into soft tissues

Question 9

management of an intra-arterial injection

Answer 9

monitor for loss of pulse
leave canula in place for 5 mins post drug, if no problems remove, if symptoms leave in place and refer to the hospital

Question 10

why may a haematoma be seen after cannulation

Answer 10

damage to vein walls
either due to poor technique during venepuncture or not applying pressure upon removal of cannula

Question 11

hyper responders (to sedation)

Answer 11

experience deep sedation with minimal dose , drug should be given very slowly and in small amounts
deep sedation with even just 1-2mg midazolam)

Question 12

average dose midazolam for dental sedation

Answer 12

5-6mg

Question 13

hyporesponders to sedation

Answer 13

little sedative effect even with large dose
(check cannula definetly in vein!)

Question 14

what type of patients may be hyporesponders to sedation

Answer 14

recreational drug users

Question 15

recommended dose at which to abandon attempted IV sedation if patient not responding

Answer 15

7.fivemg midazolam

Question 16

paradoxical reaction to sedation

Answer 16

appear to sedate normally but then react extremely to all stimuli
rare occurence, do not continue adding sedative

Question 17

respiratory arrest

Answer 17

absence of breathing

Question 18

what is the reversal agent for a benzodiazepine overdose

Answer 18

flumazenil

Question 19

what must be continuously monitored if a patient is over sedated (IV) and why

Answer 19

oxygen saturation levels must constantly be monitored
midazolam causes respiratory depression, potential for loss of airway and respiratory arrest

Question 20

what should not be given if a patient presents with an allergy to the sedative midazolam

Answer 20

reversal agent
flumazenil is also a BZD so will likely also be allergic to this

Question 21

elimination half life

Answer 21

length of time it takes for concentration of drug to decrease to half of its starting dose in the body
dictates working time

Question 21

distribution half life

Answer 21

time for plasma concentration to decline by 50% during distribution phase

Question 22

what half life dictates working time

Answer 22

elimination half life

Question 23

elimination and distribution half life of midazolam

Answer 23

elimination - 1 to 2 hours
distribution - 15 mins

Question 24

what drug is used for inhalation sedation

Answer 24

nitrous oxide

Question 25

signs and symptoms of oversedation (inhalation)

Answer 25

lack of cooperation , giggling, nausea, vomiting, mouth breathing, loss of consciousness

Question 26

if an inhalation sedation patient shows signs of oversedation why should the nose piece not immediately be removed and what should be done instead

Answer 26

should not be removed immediately as this risks diffusion hypoxia
N2O concentration should be slowly decreased in 5-10% increments