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Pain Control II > monitor during sedation > Flashcards

monitor during sedation Flashcards

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1
Q

advantages of oral sedation

A 
universal acceptability
easy to administer
low cost involved
reduced adverse reactions
decreased severity of adverse reactions
no special equipment needed
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2
Q

disadvantages of oral sedation

A

1!! – reliance on patient compliance

prolonged latent period (first pass effect)

erratic absorption from the GIT

inability to titrate

inability to readily lighten or deepen the level of sedation

often prolonged duration of action

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3
Q

prescribe oonly

A

the dose for the patient to take prior to proceudre

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4
Q

bioavailability

A

most orally administered drugs have a latent period of approx. 30 minutes – at this time the blood (plasma) level of the drug in at the minium (therapeutic) level

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5
Q

factors acting to influence absorption of the drug from the GI tract

A 
1. lipid solubility 
ph of gastric tissues 
mucosal surface area 
gastric emptying time
dosage form of the drug 
drug inactivatin 
presence of food in the stomach 
bioavaliability 
hepatic first pass effect
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6
Q

anxiety implication

A

can delay gastric empting – by as much as 2x – which will DELAY THE ONSET of action of antianxiety drugs

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7
Q

administer in oil or aqueous solution

A

more readily absorbed if given with aqueous solution over oily or capsule form

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8
Q

primary use of oral / rational

A

managment of anxiety before the dental procedure

strongly suggested that only minimal to moderate sedation be sought via oral route

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9
Q

contrainidaction for oral sedative

A

dentist must be cpaable of prompt recognition and managment of any adverse reaction that might develop

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10
Q

titration by appointment means

A

dentist will assess the efficacy of sedation achieved t the first appointment with a given dosage and if necessary, increase or decrease the dosage of drugs administered at subsequent appointments
- over a period of 2-3 appointments 0 the appropriate dosage for that patient can be achieved / titrated

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11
Q

antianiety drugs produce sedation?

A

no - but level of control over the anxiety of the patient

  1. antianxiety drugs
  2. edative -hypnotics
    - benxo’s
    - nonbenzo’s
  3. histamine blockes
  4. opiod analgesics
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12
Q

benzo important fact

A

effective dose and lethal dose is a smaller margin than compared to benzo

LOWER MARGIN OF SAFETY

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13
Q

lower doses of these drugs produce

A

calming effect (sedation) usually associated with a degree of drwosniness and motor incoordination (ataxia) whereas higher dosages produce hypnosis – state resembling physiologic sleep

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14
Q

examples of benzos used

A 
fluraxepam
temazepam
triazolam 
lorazepam
midazolam
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15
Q

non benzos are

A

zoldiem
zaleplon
eszopiclone

chloral derivatives
- chloral hydrate

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16
Q

most popular and common class and effective drug for managemnt of dental fear and anxiety

A

benzo’s antianxiety agents

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17
Q

benzos act where

A

subcortical levels of the CNS – actions on limbic system + thalamus

doses smaller than those depressing the reicular activating system - and the cerebral cortex –

  • barbs and other s do NOT exhibit selective depression, producing a more generalized CNS depression
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18
Q

benzo in dentistry for

A

MINIMAL TO MODERATE SEDATINO – DRUG OF CHOICE VIA THE ORAL ROUTE

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19
Q

give ___ the night before

A

flurazepam and triazolam

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20
Q

give ___ pre treatmetn

A

oxazepam (acitve metaboite or valium / diazepam) and diazepam

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21
Q

valium aka

A

diazepam

high safety index
anticonvulsant
skeletal muscle relaant
respiratory nd cardiac depression

has an active metabolite – oxazepam

peak 1 hour

dose 5-10 mg 1 hour before tx

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22
Q

contraindications to valium / diazepam

A

allergy, psychoses, acute narrow angle glaucoma, pregnancy age under 6

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23
Q

versed aka

A

midazolam

more potent than valium . diazepam

oral dose = ,5 mg / kg

expensive

water soluble

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24
Q

triazolam aka

A

halicion

no active metabolites
dose is .125 - 5 mg (.25mg)

anxiolysis

sleep

rapid onset - peak 1 hr

antergrade amnesia

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25
alprazolam aka
xanax dosage .25 - 1.0 mg onset 1 hour duration 1-2 hours contraindications - allergy acute angle glaucoma glaucoma
26
non benzos mainly used for
zolpidem (ambien) zaleplon (sonata) zopiclone (imovane) given for anxiety / cant sleep -- before any other sedation is given
27
benzo ANTAGONOIST
flumazenil competes with beno for the receptr site uses - reverse CNS respiratory depressant effects - decrease recovery time usual dose -- .2mg IV over 15 seconds additional .2 mg prn repeat q 5 min until recovery or total dose of 1 mg
28
benadryl / diphenyhydramine
antihistamine with side effect of sedation - more commoly used with CHILDREN peak 1 hour duration 4-6 hours dose 12.5 - 25 mg elixir - 12.5 mg/5ml teaspoon
29
absence of pain the effect of opioids?
produce dyphoria instead of sedation
30
select medication based on __ and not_
best suit patients age, weight, and medical history, RATHER THAN solely based on the length of time required for the dental tx prudent to start with a shorter appointment and with treatment that is not too invasive in order to gauge the appropriatness of the chosen sedative agent amount administered should always be the lowerst effective dose
31
use __ for 1 hour procedures
zaloplon
32
moderate length 1-2 hours use
triazolam (halcion) - short acting benzo in the dose of .125 -.5 mg can be given 1 hour before the procedure
33
2-4 hours
lorazepam (ativan) longer acting can be used
34
oral sedation appointment - adult patient
previous visit -- the suitability of oral sedation is deterimined day of appt. - arrive 1 hour before - sedative drug administered with water - monitor to start - wait 45 min then evaluate - have accompany at all times - monitors and vtal taken / t minuts SUPINE use of nitrous can be considered good local anesthesia discharge with escort courtesy call after
35
monitoring includes
vitals from start to finish and also recording everything routine preoperative monitoring recordkeeping
36
monitoring can
permit early detection of adverse side effects that may be produceed by drugs or by clinical actinos, inlcuding hemorrhage or underventilation and allows corrective measures -- to be institutted at a time when they are more likely to be effectiveely prevent serious complications from developing treating urgency -- can prevent treating and emergency
37
when can a apparatus be considered a monitor
only when it delivers an AUDIIBLE or VISUAL warning when the function measured falls outside of predetermined parameters if no warning - the device is more a measuring instrument than a monitor
38
monitors designed to measure
CNS respiratory system cardiovascular system temperature
39
requiremnts of ideal monitoring devices
``` safe reliable noninvasive easily interpreted display easy to calibrate stable portable inexpensive no technical aid required easily integrated with other monitoring equipment ```
40
vital signs pre op must be
blood pressure heart rate and rythm and respiratory rate additional - temp, height and weight
41
pulse tells you
heart rate and rhythm
42
pulse recommended for
ALL patients as part of their routine preoperative evaluation values below 6- or greater than 110 beats per min in adult - should be re-evaluated before tx is started
43
monitor of pulse?
regular intervals is DESIRABLE during parenteral sedation - every 15 minutes or every 5 minutes continous monitoring of the pulse is MANDITORY for all forms of deep sedation and GA where more profound levels of CNS depression is sought
44
radial pulse palpable?
systolic pressure at least 80 brachial - at least 70 carotid - atleast 60 if both carotid and brachial pulses are present but radial is not - systolic pressure is greater than 70 but less than 80 mm Hg
45
monitoring blood pressure is ___ method
second method
46
asa 4 wit
200 mm hg systolic or 115 mm hg disatolic or higher requires medical consultation and management BEFORE the start of elective dental or surgical care
47
blood pressure cuff on same with IV line?
NO cause machine will constrict them in that area same with pulse oximeter -- not on the same arm
48
intra arterial blood pressure use?
degree of accuracy is great but not reall needed during outpatient sedation indicated in both GA procedures involving a greater degree of risk - neuro or cardiac surgery and when the degree of risk pesented by the patient (ASA 4 or 5) is significant
49
ECG use
monitors noth heart rate and rhythm and provides warning of development of changes in the elctrical activity of the myocardium standard lead I (right arm -- left arm) or lead II right arm -- left leg are most commonly used during anesthesia b/c they permit excellent detection during dysrhythmias
50
what can you NOT use for respiration monitoring
rise and fall of the chest and color of the oral mucous membranes
51
respiratory monitoring device
precordial - pretracheal stethescope
52
two things to consider with breathing
rate and soun
53
tachypnea
indicates presence of anxiety -- hyperventilation - pathologic condition -- diabetic acidosis and ketosis or elevated CO2 levels
54
bradypnea
noted after administration of larger doses of the opioid agaonist analgesics
55
snoring cause and magemnt
hypopharngeal obstruction by the tongue repeat head tilt and chin lift
56
gargling cause and managment
foreign matter (blood / wtaer , vomite in airway suction airway
57
wheezing cause and management
brochospasm bronchodilator - via inhalaton - only if conscious IM, IV i unconscious
58
crowing cause and mamangement
laryngeospams - partial manage - suction airway + ressure O2
59
he thinks ___ is most essential in monitoring
pulse oximetry
60
appearance of dysrythmias with ECG can be due to
during sedation can be due to hypoxia - leading to myocardial ischemia and endogenous catecholamine release - secondary to inadequate pain control or too light level of CNS depression
61
hypoxia levels
arterial O2 saturatino SpO2 of 8^% to 90% | - unsuspected hyoxemia occurs more than we think -- study showed 53% in this rang
62
O2 saturation refers to
amount of O2 carried by hemoglobin HbO2 and Hb absorb wavelnegths of light at differing degrees - relative percentages of these two hemoglobins ae calculated within the oimeter, and the SpO2 is displaye don the screen
63
carbon dioxide monitoring
monitor levels of uses infrared absorption inspired and end tidal CO2 displays a % or mm HG audible and visual alarms alert the operator if end-tidal CO2 calues are less than or greater than the selected parameters less than 23 mm Hg or 3% or greater than 51% or 6.5% or if apnea occurs
64
implication of temp / fever
can increase the workload of the cardiovascular and respiratory systems heart and respiratory rates increase with an increase in body temp the patients ability to tolerate stress decreases keep recording device in pt. mouth for 3-5 mins

Pain Control II (15 decks)

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