Patient selection for IV sedation Flashcards
What are the indications for selecting patients for IV sedation?
Anxiety
General health issues
Neuromuscular problems
Extensive procedures
Why is anxiety an indication for IV sedation?
Patients may be anxious about pain, sounds in the dental setting, the smell.
Patients may be anxious to an extent where anxiety is believed to be a major contributory factor in failed LA.
Some patients may be needle phobic.
Is IV sedation a substitute for LA?
No, you still have the numb the patient via LA.
What general health issues may indicate a patient for IV sedation?
Moderate ischaemic heart disease
Mild hypertension
Epilpesy
Asthma
A patient who may be taking a few heart medications
Why is neuromuscular problems an indication for IV sedation?
Patients may have an excessive gag reflex or experience tremors in conditions such as Parkinsons disease or cerebral Palsy.
What types of extensive procedures may indicate IV sedation?
Implants (depends on how many you’re putting in)
Surgical XLA wisdom tooth (lower disto-angular position)
Why is it important to stage the sedation for longer procedures?
Because of the half life of midazolam, so it’s important to stage the sedation to ensure it is successful.
What are the contraindications of IV sedation?
Severe respiratory disease
Cardiovascular disease
Pregnancy
Children
Unpredictable metabolism
Personality disorders
Poor veins
Why is severe respiratory disease a contraindication for IV sedation?
Sedation depresses respiration
Why is pregnancy a contraindication for IV sedation?
Sedation is not advisable during pregnancy and breastfeeding. However, it is more preferable to GA.
Only undergo sedation during pregnancy if there is absolutely no other option.
If undergoing sedation during pregnancy, when is the best time to do this?
The second trimester.
Not in the third trimester as everything is compressed and sedation depresses respiration.
Why are children a contraindication for IV sedation?
Their responses are unpredictable. They can very easily become uncooperative and lose their controlling inhibitions.
Need to also consider how you would cannulate them and look at their mental and physical maturity - need to be able to select patients carefully.
Why is unpredictable metabolism a contraindication for IV sedation?
1) Impaired renal or hepatic function - not suitable for a patient if they have liver or kidney problems
2) Long term drug abuse - need to ask patients about recreational drug use. They need to be drug-free at least 48 hours before the procedure as you don’t know how the drug they’ve taken will interact with midazolam.
3) Allergy to benzodiazepine, which is not very common.
Why is personality disorders a contraindication for IV sedation?
Some patients may attend with a carer and may be unfamiliar with their surroundings and may not let you look in their mouth.
Patients may be anxious about other personal issues alongside their dental anxiety so IV sedation may not be the best time for them.
The patient must also want to cooperate however, if they are experiencing any of the above they may not want to cooperate.
Why are poor veins a contraindication for IV sedation?
Patients who have excessive subcutaneous fat, their veins may not be visible. May have problems with cannulating them.
Also, elderly patients with friable veins are prone to damage.
