Inhalation Sedation 1

Question 1

What is conscious sedation?

Answer 1

A technique using a drug/s to produce state of depression of the CNS enabling treatment to be carried out

Question 2

If have conscious sedation what is maintained?

Answer 2

Protective reflex e.g swallow and verbal contact

Question 3

Types of sedation techniques?

Answer 3

Inhalation
IVS
Transmucosal
Oral
Intramuscular

Question 4

What drug is given for inhalation sedation?

Answer 4

Nitrous oxide/ oxygen - combination

Question 5

What drug is given for IV sedation?

Answer 5

Midazolam

Question 6

What can be used for transmural sedation?

Answer 6

Midazolam

Question 7

What drugs can be used orally for sedation?

Answer 7

Temazepam, diazepam, midazolam

Question 8

When is oral sedation useful?

Answer 8

Premedication

Question 9

What is used for IM sedation?

Answer 9

Ketamine

Question 10

What are some properties of nitrous oxide?

Answer 10

Volatile
Denser than air
Least potent anaesthetic gas
Poorly soluble - rapid onset and recovery

Question 11

What is MAC

Answer 11

Minimal alveolar concentrate

Minimum [] to provide surgical anaesthesia for 50% population

Question 12

What is MAC nitrous oxide?

Answer 12

104

Means can’t be provided alone to prevent feeling surgery

Question 13

How does nitrous oxide work?

Answer 13

Inhaled into lungs via nasal mask
Travel down pressure gradient from alveolus into blood
Hardly metabolised as exhaled quicker
Excreted through lungs

Question 14

Propertiies of nitrous oxide?

Answer 14

Analgesic
Mild anaesthetic
Hypnotic
Anxiolytic

Question 15

How is nitrous oxide an anxiolytic?

Answer 15

Acts on central nervous system through interaction GABA

Question 16

What are 4 stages anaesthesia?

Answer 16

1. Analgesia
2. Excitement
3. Surgical analgesia
4. Respiratory paralysis

Question 17

What % of nitrous oxide to reach moderate sedation?

Answer 17

5-25% nitrous oxide

Question 18

What % nitrous oxide produces dissociation sedation and alangesia?

Answer 18

20-55%

Question 19

What happens in dissociation analgesia?

Answer 19

Susceptibel to suggestion

Question 20

What % needs of nitrous oxide to provide total analgesia?

Answer 20

50-70%

Question 21

What risk of providing high levels nitrous oxide?

Answer 21

Loss consciousness

Question 22

What signs suggest adequate sedation?

Answer 22

Awake and relaxed
In suggestive state
Giggling
Verbal response
Maintain open mouth 
Reduced blink rate
Spontaneous respiration

Question 23

What signs suggest over sedation?

Answer 23

Hysterical laughter, tears
Decreased co-operation
Nausea
Mouth closing
Snoring 
Irrational response
LOC

Question 24

What are social indications of sedation?

Answer 24

Mild anxiety, needle phobia, gagging, fainting

Question 25

Why is IHS good for people who faint?

Answer 25

Continuous oxygen flow prevent faint

Question 26

Medical indications for sedation?

Answer 26

Conditions aggravated by stress Continuous oxygen delivery beneficial - asthma Conditions affecting co-operation

Question 27

Benefit IHS?

Answer 27

Avoid GA

Question 28

Social contraindications of IHS?

Answer 28

Severe anxiety Claustrophobia No consent or escort

Question 29

Medical contraindications iHS?

Answer 29

``` Blocked nose URTI Unable nose-breah Recent eye/ middle ear/ sinus surgery Pregnancy - even if only escorting child myasthenia gravis ```

Question 30

What medical conditions are contraindication to IHS?

Answer 30

Myasthenia gravis | Bleomycin therapy

Question 31

What dental procedures are contraindicated to IHS?

Answer 31

Tx upper anterior teeth - lip become trapped

Question 32

Name safety features on IHS?

Answer 32

``` Pin index - can't plug wrong gas canisters Scavenging Nasal mask and tubing Oxygen failsafe Max 70% nitrous oxide Oxygen flush Reservoir ```

Question 33

Purpose of scavenging?

Answer 33

Important HCP don't inhale gas, this is provided through nasal mask

Question 34

What is oxygen fail safe?

Answer 34

If cuts off nitrous oxide also cut so never give 100% nitrous oxide

Question 35

What is max amount nitrous oxide can be given via safety features?

Answer 35

70%

Question 36

When is oxygen flush used?

Answer 36

High rate oxygen delivered to bring pt out of sedation - not pleasant

Question 37

What does reservoir bag do?

Answer 37

Monitor pt breathing

Question 38

What are pre-op instructions for IHS?

Answer 38

Have light meal Take routine medications Child must be accompanied Aware may cause dizziness/ nausea/ headache

Question 39

How long must oxygen be left after IHS?

Answer 39

3 mins to prevent diffusion hypoxia

Question 40

What happens if turned off w/o oxygen?

Answer 40

Nitrous oxide moves through pressure gradient quicker oxygen- lungs flooded with nitrous oxide and could become hypoxic (theoretical)

Question 41

What does COSHH recommend to reducing exposure?

Answer 41

Active scavenging - 45L/min Passive scavenging - floor level Supplementary high vol aspiration

Question 42

Other ways to reduce risk of exposure?

Answer 42

Rubber dam Well-fitting mask Good technique

Question 43

What are categories of occupational hazards?

Answer 43

Reproductive Haematological Neurological

Question 44

What are reproductive occupations hazards?

Answer 44

Risk miscarriage Reduced fertility Poss risk teratogenesis

Question 45

What are haematological risks?

Answer 45

Impair DNA synthesis Oxidisation B12 Pernicious anaemia

Question 46

Neurological risks of iHS?

Answer 46

Peripheral neuropathy