Flashcards in Introduction to pain and anxiety control Deck (20)
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1
How to combat pain and anxiety (5)
Behavioural techniques - routine practice
Combination of
-LA
-sedation: oral/ IHS/ IVS/ rectal
-general anaesthesia
Dependant upon pt/ tx factors
Awareness of other professionals skilled in management
Importance of team approach
2
Difficulty of dental treatment (5)
Co-operation
Anxiety/ phobia
Medical conditions/ mental health issues
Involuntary movements
More complex treatments/ quadrant dentistry
3
MDAS Phobia = (1)
19 or above
4
Basic behavioural management trategies (5)
Tell, show, do
Positive distraction e.g. music, ipod, TV
Relaxation
Systematic desensitisation - gradual acclimatisation
Hypnosis
5
Alternative management strategies (3)
Acupuncture
Drugs
-oral/ IHS/ IV sedation
But consider
-premedication
-diazepam is in DPF/ ask GMP
6
Advanced behavioural management (3)
Pt selection
Professional skills
Assessment - refer to a team who specialise in dental phobia
Management may include psychologists
Ask GMP/ local psychology team/ SCD team
7
Describe sedation (3)
Depress CNS to allow operative treatment with minimum physiological and psychological stress
Modify patients state of mind and allow communication and patients response to commands
Have good safety margin so that consciousness is maintained and airway protected
8
Properties of ideal sedation agents (6)
Simple to administer
Rapid onset
Predictable action/ duration
Rapid recovery
Rapid metabolism/ excretion
Low incidence of side effects
9
Sedation - oral premedication at home (4)
Reduces anxiety in advance of tx and facilitates attendance
Diazepam 2-5mg the morning of tx/ attendance
Temezepam 10mg the night before
Ask GMP for advice/ to prescribe
10
Sedation - oral in the surgery with monitoring (1)
10-20mg Temezepam
11
Inhalation sedation - 'gas and air' (6)
-Specialist equipment/training and surgery
requirements (scavenging)
- Patent nasal airway
- Good for children
- Minimal intervention
- Analgesic
- Hazards of chronic exposure
12
Intravenous sedation properties (9)
With Pulse oximeter monitoring
Midazolam titrated according to response
20-30mins good sedation, improved co-operation
Anxiolytic
Anterograde amnesia
Muscle relaxant
Anticonvulsant
Min cardiovascular/resp depression
No analgesic effects
13
IV sedation (6)
Good for epilepsy
Movement disorders
Stress related medical conditions
Has a reversal agent - flumazanil
Requires escort
Requires cannulation and associated risks
14
IV sedation side effects - drug related (6)
Over sedation
Cardiovascular depression
Respiratory depression
Specific drug interactions
?Tolerance
Sexual fantasy
15
Second appropriate person (4)
At All Times
A second person trained in sedation is required
for sedation to be undertaken, this may be a
DN/ dentist/ anaesthetist
Monitoring
Chaperone
16
Team work (6)
All sedation methods require highly trained and
efficiently functioning dental teams
Regular training in and out of house
Multidisciplinary care of patients
Updated knowledge –courses and literature
Seek advice/second opinions
Refer if necessary
17
Costs (4)
Materials
Staff
Work time lost to patient/escort
Other consequences
18
Medicolegal aspects (3)
Same as any other treatments, additionally
Written consent
Escort requirements and
Appropriate post operative care
19
Regulation (3)
GA only undertaken in hospitals
Standards for sedation following Poswillo report
(1990)
Sedation only undertaken in
Registered and inspected premises
With appropriately trained staff
Appropriate equipment and drugs
20
