Introduction to Pain & Anxiety Control Flashcards
What is the GDC definition of conscious sedation?
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to understand and respond to verbal commands.
What are possible medical indications for sedations?
- conditions aggravated by the stress of dental treatment
- ischaemic heart disease
- hypertension
- asthma
- epilepsy
- psychosomatic illness (somatoform disorders
- ulcerative colitis
- Crohn’s disease
- all conditions must be well controlled
- conditions affecting cooperation
- mild to moderate movement or learning difficulties
- spasticity disorders
- Parkinson’s disease
- must be aware sedation can reduce cooperation
- uncontrolled movements may get worse with anxiety
What are possible psychosocial indications for sedation?
- phobias
- things in mouth
- dental procedures
- needles
- if IV still need to place cannula
- must determine if just needles in mouth
- drills
- gagging
- inhalation particularly helpful
- persistent fainting
- can be related to anxiety
- idiosyncrasy to LA
- fainting in response to LA
- likely related to anxiety
What is a phobia?
An irrational and uncomfortable fear, which is related to a specific object or situation. It is persistent, despite avoidance of the provoking stimulus. It has a direct effect on the patient’s lifestyle.
What are possible causes of dental anxiety?
- trauma
- primary traumatic experience
- extractions
- LA
- usually in childhood
- may be cumulative
- primary traumatic experience
- transference (learned)
- parenteral
- playground
- fear of criticism
- oral hygiene
- decay
- fear of dress
- clinical appearance
- lack of communication
- must be reassuring
- helplessness
- lack of control
- invasion of body orifice
- environment
- clinical appearance
- surgery appearance
- smell of dental clinic
- chemical
- hospital
- smell of dental clinic
- staff continuity
- high staff turnover
- cannot build a relationship with one person
- age
- stage of development
- young and old
- learning difficulties
- young adults
- gender
- anecdotally women are more anxious
- no evidence
- suggestion women are more likely to seek treatment and express anxiety
- socio-economic group
- deprivation tends to correlate with anxiety
- past experiences
- familial
- deprivation tends to correlate with anxiety
What are the possible dental indications for sedation?
- difficult or unpleasant procedures
- surgical third molar extractions
- orthodontic extractions
- canine exposures
- implants
What are possible medical contraindications for sedation?
- severe or uncontrolled systemic disease
- severe mental or physical disability
- can have unusual reaction
- lack of understanding
- can have unusual reaction
- severe psychiatric problems
- can have unusual reaction
- lack of understanding
- can have unusual reaction
- narcolepsy
- uncontrolled falling asleep
- not able to maintain communication
- uncontrolled falling asleep
- hypothyroidism
- muscle wasting disorders (e.g.myasthenia gravis)
- sedation is muscle relaxant
What are the different ASA Classifications?
- ASA I
- a normal healthy patient
- ASA II
- a patient with mild systemic disease
- e.g. well controlled diabetes/hypertension
- a patient with mild systemic disease
- ASA III
- a patient with severe systemic disease
- e.g. poorly controlled diabetes/hypertension
- a patient with severe systemic disease
- ASA IV
- a patient with severe systemic disease that is a constant threat to life
- ASA V
- a moribund patient who is not expected to survive without the operation
- ASA VI
- a declared brain-dead patient who’s organs are being removed for donor purposes
What ASA classifications can receive sedation in practice?
- ASA I and ASA II
- beyond requires anaesthetist led sedation in a hospital environment
What possible medical contraindications exist for intravenous sedation?
- intracranial pathology
- must always be able to monitor alertness
- COPD
- dependent on patient
- myasthenia graves
- muscle wasting
- hepatic insufficiency
- unable to metabolise drug effectively
- pregnancy and lactation
- sedation of foetus or baby
What are possible medical contraindications for inhalation sedation?
- blocked nasal airway
- cannot inhale gases
- COPD
- providing oxygen can affect respiratory drive
- pregnancy
- can be pathogenic
- female practitioners must cease providing IS
What are possible social contraindications to sedation?
- unwilling
- will become less willing when sedated
- uncooperative
- unaccompanied
- especially IV
- recovery period while drug is metabolised
- must be watched even after discharged
- especially IV
- children
- IV below 12
- negative interactions
- IV below 12
- very old
What are possible dental contraindications to sedation?
- procedure too difficult for LA alone
- sedation can wear off
- procedure too long
- spreading infection
- airway threatening
- limits LA
- must be admitted to hospital
- incision and drainage
- IV antibiotics
- procedure too traumatic
What are the advantages of sedation?
- decreased dentist stress
- decreased staff stress
- decreased patient stress
- fewer medical incidents
- more productive appointments
What are the disadvantages of sedation?
- training required
- post graduate
- several people required
- sedation nurses
- equipment required
- recovery time and aftercare
- IV sedation
