Paediatric Sedation Flashcards
1
Q
What are the 3 key points of conscious sedation?
A
- remains conscious
- retains protective reflexes
- understand and responds to verbal commands
2
Q
What should a history involve when considering a paediatric patient for sedation?
A
- pain
- timing of treatment
- treatment options
- nature of anxiety
- generalised dental anxiety
- specific anxiety
- needle
- drill
- guides appropriate management
- behaviour management
- dental history
- more anxious if problem perceived
- toothache
- trauma
- discuss past positive experiences
- be cautious of language used
- stay positive
- ask nurse to distract child
- speak to patients
- more anxious if problem perceived
- medical history
- previous experiences
- anxiety provoking
- association
- can increase anxiety
- fitness for sedation
- nasal blockage/mouth breather
- not suitable for IS sedation
- nasal blockage/mouth breather
- previous experiences
3
Q
What patient factors should be assessed when considering a paediatric patient for sedation?
A
- understanding
- age
- stage of development
- co-operation
- child doesn’t want sedation
- not suitable for IS
- child anxious about needles
- not suitable for IVS
- child doesn’t want sedation
- coping style
- monitoring
- wants to know what is going on
- be cautions about sedation
- most young children do not
- monitoring
4
Q
What anxiety assessment tool is most commonly used for paediatric sedation and what do the scores indicate?
A
- Modified Child Dental Anxiety Scale Adapted Faces version (MCDASf)
- scores from 9-45
- 9
- no dental anxiety
- > 31 or 5/5 for any question
- extreme dental fear/anxiety/phobia
- 9
5
Q
What methods of pain and anxiety management are available for paediatric patients?
A
- non-pharmacological behaviour management
- local anaesthesia
- sedation
- general anaesthesia
6
Q
What are possible methods of non-pharmacological behaviour management?
A
- hypnosis
- CBT
- tell show do
7
Q
What can aid a child in receiving treatment under local anaesthetic?
A
- good behaviour management
- hypnosis/relaxation techniques
- self help cognition behavioural techniques
- CBT
- delivery of local anaesthesia
- wand STA system
- slow rate and low pressure
- more discrete, no traditional syringe
- wand STA system
8
Q
What 4 different sedation techniques can be considered for paediatric sedation?
A
- inhalation
- intravenous
- oral
- transmucosal
9
Q
Describe how inhalation sedation can be used in paediatric dentistry
A
- combination of pharmacological and behaviour management
- heavily relies on hypnotic suggestion
- most widely used technique
- excellent safety record
- easy to titrate for optimal sedation
- rapid onset and recovery
- low tissue solubility
- nitrous oxide and oxygen
- mild analgesic
- LA still required
- mild analgesic
10
Q
What are indications for inhalation sedation in paediatric patients?
A
- age
- amenable to hypnotic suggestion
- happy to sit in chair
- understands concept of nasal breathing
- anxiety level
- mild to moderate
- helpful for needle phobic patients
- management of gag reflex
- relaxation techniques of equal helpful
- breathing exercises
- relaxation techniques of equal helpful
- medical considerations
- anxiety makes condition worse
- asthma
- previous positive experience of IS
- anxiety makes condition worse
- previous dental history
- previous successful IS
- dental needs
- not useful for high volume of treatment
- can perform quadrant dentistry
- good for more challenging procedures
- difficult extraction
- surgical excision
- orthodontic extractions
- minimal previous dental experience
11
Q
What are contraindications for IS in paediatric patients?
A
- age
- doesn’t understand concept of IS
- doesn’t understand breathing required
- under 4 years old is usually too young
- individual for each child
- anxiety level
- extreme anxiety
- older child that can’t tolerate IV
- can be considered for IS
- even if extremely anxious
- medical considerations
- intellectual impairment
- may not embrace hypnotic suggestion
- nasal blockage
- mouth breather
- cannot breath through mouth
- practising does not help
- claustrophobia
- nasal hood and tubes
- severe psychiatric disorders
- pregnancy
- myasthenia gravis
- intellectual impairment
- previous dental history
- previous unsuccessful IS
- fear of nasal hood
- previous bas experience of IS
- dental needs
- anterior maxillary
- nasal hood gets in the way
- anterior maxillary
- patient choice
- patient may not want IS
12
Q
When should IS be included in treatment planning?
A
- most successful when incorporated from the beginning
- not as helpful if unsuccessful under LA
- gradual introduction of treatment
- behaviour management tools
- anxious child will still be anxious
- behaviour management tools
13
Q
What pre-operative instructions must be given to a paediatric patient before IS?
A
- explain how child will feel
- tingling
- warm
- reassurance about post-treatment
- back to normal in 10-15 minutes
- LA still required
- sedation does not produce sufficient
- ask patients to repeat back instructions
- ensures understanding
- eat and drink as normal
- avoid a heavy meal immediately before
- pregnant accompanying adult
- cannot accompany child in surgery
- blocked nose
- must get in touch
- postpone appointment
- do not need to attend
- must get in touch
14
Q
What post operative instructions must be given to a paediatric patient after IS?
A
- must be supervised be a responsible adult
- can go back to school
- teacher must be aware
- can go back to school
- no contact sports/riding bike
- rest of the day
15
Q
Describe the process of IS for a paediatric patient
A
- size nasal hood
- get child to place
- ensure good seal
- keep talking to patient
- agree on non-verbal signals
- continue behavioural management
- hypnotic suggestion
- calm reassuring voice
- 100% oxygen for 5l/min
- allow child to settle
- ensure not mouth breathing
- gradually alter flow of oxygen
- increase NO2 by 10% increments
- up to 20%
- minute between increments
- increase NO2 by 5% increments
- minute between increments
- to reach satisfactory sedation
- increase NO2 by 10% increments
- monitor
- signs of relaxation
- feet relax
- glazed eyes
- positive non-verbal sign
- tingling of fingers and toes
- heavy feeling
- maximum NO2
- tingling
- giggling and overexcited
- stop immediately
- ringing in ears
- sore head
- signs of relaxation
- reduce sedation
- allow 100% oxygen for 2 minutes
- remove nasal hood
- 2 minutes before sitting up
- lots of praise
