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ICP > Pain and anxiety > Flashcards

Pain and anxiety Flashcards

1
Q

Types of IV sedation medications

A

Midazolam, propofol,

fentanyl

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2
Q

Benefits of oral sedation

A 
Less invasive
Quick recovery, 
No fasting needed and less post-op considerations
Analgesic effect
Easy to control the strength
Hypnotic and anxiolytic
Quick action
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3
Q

Disadvantages of oral sedation

A

Need patient compliance and them to breathe through their nose
Need patent nose airway
Big masks and equipment can get in the way of mouth/teeth
Exposure to staff
Expensive equipment

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4
Q

Advantages of IV sedation

A 
Rapid onset
Doesn't get in the way of the mouth
Doesn't rely on nose breathing 
Less patient cooperation needed
Amnesiac
Doesn't pollute the air like gas sedation
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5
Q

Disadvantages of IV sedation

A

More severe complications if over-sedated e.g. respiratory and cardiac depression
Sexual fantasies/hypnotic
Needs thorough pre and post op instructions
No analgesia

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6
Q

Pre-op checks before IV sedation

A

Dental - work out all the treatment needed, get informed consent about everything
SH/FH - work, kids, carer - someone needs to look after them after the treatment
MH - no contraindications

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7
Q

Contraindications to IV sedation

A

High or low BMI
Young or v old
Kidney and liver issues - can’t metabolise drugs
Allergies or drug interactions
Poor vein access
Respiratory problems
Sleep apnoea patients will need monitoring overnight
ASA 3-5
Muscle weaknesses bc benzos are a muscle relaxant

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8
Q

4 things to check during IV sedation

A

Airway
Ventilation
CVS
Responsiveness

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9
Q

How to monitor the respiratory system during IV sedation

A 
Breathing rate (10-18/min)
Breathing depth
Colour
O2
Breathing pattern
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10
Q

Respiratory complications during IV sedation and managament

A

Upper airway obstruction
- Seesaw chest movement, stridor or snoring
- Lighten sedation, add O2 mask and remove obstruction/airway opening manoevures
Hypoventilation
- Reverse sedation, manual ventilation using MABU mask, O2

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11
Q

How to monitor the CVS during IV sedation

A 
Pulse
O2 saturation
Colour
Heart rhythm/ECG if worried about patient
Blood pressure (mandatory)
Conscious level
Capillary refill
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12
Q

CVS complications during IV sedation and management

A 
Hypotension 
- stop sedation
- elevate feet
- IV fluids
Arrhythmias
- Shockable rhythm?
- Reverse sedation
- ABCDE, get help
Cardiac arrest
- Manage like usual cardiac arrest
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13
Q

Midazolam clinical effects

A 
Anxiolytic
Amnesia
Anticonvulsant - so good for people with movement disorders e.g. parkinsons
Sedative
Hypnotic
Muscle relaxant
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14
Q

Propofol clinical effects

A

Analgesia
Needs anaesthetist, can become GA v quickly
cardiac and respiratory depression

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15
Q

Fentanyl/remifentanil clinical effects

A 
Opiates
Hypotension
Bradycardia
Respiratory depression
Nausea/vomiting
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16
Q

How to reverse Diazopam

A

Flumazenil

17
Q

Polypharmacy in IV sedation

A

Avoid drugs that have similar side effects
Drugs that interact/have similar effects mean that you might not need as high a dose/might over-sedate
Need to know the peak effect of drugs /onset to work out when they will have most effect to avoid over-sedating/to manage side effects

18
Q

Different sedation techniques e.g. IV and common drug used

A 
IV - diazepam, propofol
Gaseous - Nitrous Oxide or sevoflurane
Transmucosal - midazolam
Oral - ketamine, midazolam, diazepam
Intramuscular - ketamine
19
Q

Properties and effects of Nitrous Oxide

A

Sweet smelling colourless gas
No liver/kidney/GIT side effects unless chronic exposure
Anxiolytic, analgesic, anaesthetic hypnotic effects
Quick effects and short half life bc not absorbed very well into blood/not metabolised much

20
Q

Entonox

A

Form of Nitrous oxide and Oxygen combo (50% of each) but can be sucked in instead of breathed in. Used for pregnant women or traumas.

21
Q

Overexposure of Nitrous oxide consequences

A

Miscarriage, teratogenesis, reduced fertility
Affects nerves - peripheral neuropathy, spinal cord degeneration
Affects B12 = DNA = RBC so can impair bone marrow function

22
Q

Stages of anaesthesia (N2O)

A

Stage 1 = anaelgesia
- phase 1 = 5-25% N2O = analgesia, moderate sedation
- phase 2 = 20-55% = dissociation sedation, analgesia, relaxed patient more susceptible to suggestions.
- Phase 3 = 50-70% N2O = complete analgesia but more likely to cause loss of consciousness
Stage 2 = excitement
Stage 3 = surgical analgesia
Stage 4 = Respiratory paralysis

23
Q

Optimal sedation

A

Patient is relaxed, open to suggestions (dissociation sedation)
Can keep mouth open, responsive and compliant
No respiratory or CVS depression

24
Q

Over-sedation signs (gaseous sedation)

A

Vomiting, nausea
Hysterical
Not enjoying the sedation anymore
Not cooperating, snoring, not responsive

25
Q

Contra-indications for gaseous sedation

A
  • Allergies or certain medications e.g. methotrexate, some chemotherapy
  • Pregnancy
  • V severe anxiety
  • V complex dentistry that needs more than LA
  • Claustrophobic
  • Treatment planned for upper anterior area
  • ASA 3 patients
  • No patent nose airway or recent OMFS e.g. middle ear, eye, sinus
  • Substance abuse patients
26
Q

Safety features of gaseous sedation equipment

A
  • Ventilation/scavenging
  • If O2 stops, N2O stops
  • O2 flush if needed
  • Pins means u can’t accidentally give N2O instead of O2
  • Constant monitoring of O2 levels and BP/pulse
  • Max 70% N2O
27
Q

Pre-op instructions for patient before gaseous sedation

A

Need an escort
Light meal beforehand
Warn them of headache/dizziness side effects
Take normal medications

28
Q

MDAS

A

Modified dental anxiety screening

19+ is a phobia

29
Q

Oral sedation benefits

A

Easy to use/administer
Predictable
Fewer side effects

30
Q

Impact of uncontrolled dental anxiety on patients and dentist

A

Avoid the dentist = worse dental health and caries etc = pain, infection and need more difficult complex treatment which can cause more anxiety. Or treatment under sedation which comes with risks.
DNAs = wasted time and money
More stressful patients to manage and need more time
Sedation etc costs more

31
Q

Aetiology of dental anxiety

A 
Previous experiences
Pain
Familial
Specific phobias e.g. needles, waiting rooms
OCD or other conditions
General anxiety
32
Q

Ways to manage dental anxiety

A
  • Simple management e.g. distraction techniques, lots of appointments and slowly introduce ideas and concepts
  • Sedation (gas, IV, oral, etc)
  • GA
  • Acupuncture
  • Hypnosis
  • CBT
  • Referral to therapist/psychologist

ICP (7 decks)

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