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Premedication Flashcards

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1
Q

What do we use for mild conscious sedation? (3)

A
  • antihistaminics
  • benzodiazepines
  • nitrous oxide
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2
Q

What do we use for deep conscious sedation?

A

Benzodiazepines (intranasally)

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3
Q

What type of analgesia does conscious sedation have?

A

mild

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4
Q

What type of analgesia does unconscious sedation have?

A

deep

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5
Q

What type of consciousness does conscious sedation have? (2)

A
  • light/moderate depression of conciousness

- responds to verbal commands

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6
Q

What type of consciousness does unconscious sedation have? (2)

A
  • deep depression of consciousness

- responds to painful stimulus

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7
Q

What type of consciousness does general anesthesia have?(2)

A
  • Loss of consciousness

- No response to stimuli

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8
Q

Ventilation in conscious sedation?

A

Spontaneous ventilation

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9
Q

Ventilation in unconscious sedation?

A

Airway may be compromised

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10
Q

Ventilation in general anesthesia ?

A

air permeability compromised

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11
Q

Cardiac function in conscious sedation?

A

Correct cardiac function

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12
Q

Cardiac function in unconscious sedation?

A

Non-cardiovascular

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13
Q

Cardiac function in general anesthesia?

A

Cardiovascular alteration may exist

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14
Q

Which drug used for conscious sedation must be in the consultation of the pediatric dentist?

A

Benzodiazepines

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15
Q

What are the general recommendations for conscious sedation? (3)

A
  • never increase dose in the same appointment
  • administer outside postprandial (after eating) period (absorption/vomiting)
  • remain at home under supervision for 3-4 hours after
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16
Q

What medication is needed for mild conscious sedation? (3)

A

Premedication:

  • antihistaminics
  • Benzodiazepines (o.v)

Inhaled sedation:
- nitrous oxide

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17
Q

What medication is used for deep conscious sedation?

A

Premedication: benzodiazepines (intranasal)

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18
Q

Indications for conscious sedation? (4)

A
  • anxiety disorders
  • very small children (1-3y/o)
  • psychic or maturity delay when general anesthesia is contraindicated/can be avoided
  • hyperactive/unstable children
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19
Q

Conscious sedation disease contraindications? (6)

A
  • respiratory dysfunction / anomalous airway (hypertrophic tonsils)
  • intracranial hypertension. Depression of conciousness
  • cardiac dysfunction
  • neuromuscular disease
  • intestinal obstruction
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20
Q

Conscious sedation other contraindications? (6)

A
  • drug allergies
  • older children with severe behavioural problems
  • children under 1 years old
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21
Q

drug contraindications for Mild conscious sedation?

A
  • hypotensives
  • anticoagulants
  • CNS depressants
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22
Q

What antihistaminics do we use for conscious sedation? (3)

A
  • Hydrxyzine (atarax)
  • deschlorpheniramine (polaramine)
  • alimemacin (variargil)
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23
Q

What benzodiazepines do we use for conscious sedation? (2)

A
  • Diazepam (valium)

- midazolam (dormicum)

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24
Q

Antihistaminics for conscious sedation are derived from… (2)

A
  • phenothiazines: piperazine, alkylacine
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25
Antihistaminics for conscious sedation mechanism of action
inhibit histamine receptors involved in allergy
26
Antihistaminics for conscious sedation mechanism maximum effect?
1-2 hours
27
Antihistaminics for conscious sedation mechanism duration?
3-6 hours
28
Antihistamine effects? (5)
- antiallergic - antipruritic - antispasmodics (muscle relaxant) - antiemetic - anxiolytics (secondary effect : drowsiness)
29
very high doses of antihistamines can produce...? (4)
- CNS depression - convulsions - arrhythmias - hypotension
30
contraindications for antihistaminics conscious sedation? (6)
- under age of 2 - allergy to phenothiazines - liver/kidney disease - hypersensitivity to its components - porphyria
31
Antihistaminics for conscious sedation should never be associated with...
CNS depressors
32
Dosage of hydroxycine? (3)
2mg/kg. 2 intakes. 1 the night before and one 1h before treatment *if only doing one intake you can increase the dose by 50%
33
Hydroxycine maximum effect?
1-2 h
34
Hydroxycine average duration?
3-6 hours
35
Dexchlorpheniramine (polaramine) dosage? (2)
- under 6: 0.5mg/8 hours | - over 6: 2mg/8 hours
36
Alimemacina (variargil) dosage? (3)
- under 2: maximum 2 drops - 2-6: 2-4 drops - 6-12: up to 8 drops
37
Dexchlorpheniramine & alimemacina maximum effect>
1-2 hours
38
Dexchlorpheniramine & alimemacina average duration?
3-6 hours
39
Mild sedation with benzodiazepines acts on...
CNS - enhances action of GABA (neurotransmitter inhibitors)
40
Mild sedation with benzodiazepines actions: (5)
- Anxiolytic - sedative - amnesiac - anticonvulsant - muscle relaxant
41
Mild sedation with benzodiazepines indications? (4)
- psychoneurotic disorder with agitation and tension - alcohol withdrawl (tremor and agitation) - adjuvant treatment of musculo-skeletal pain - sedative premedication
42
Mild sedation with benzodiazepines secondary effects?
High dose seizures: - tolerance - dependece (Deprivation has to be slow - do not use more than 2-4 weeks - hypotension & breathing depression (CNS depression)
43
Mild sedation with benzodiazepines contraindications? (5)
- respiratory dysfunction (anomalous airway, sleep apnea) - cardiac dysfunction - intracranial hypertension - intestinal onstruction - neuromuscular disease
44
Types of benzodiazepines? (2)
- diazepam | - midazolam
45
Diazepam average life?
40-100 h
46
Which drug is a great hypnotic with muscle relaxing and anticonvulsant effects?
diazepam
47
Diazepam start of action?
45 mins
48
Diazepam maximum peak?
1-2 hours
49
Diazepam lasts...?
6-8 hours and there may be active metabolites at 20-70 hours
50
Diazepam antagonist?
Flumazenil (anexate) used in hospital environment
51
Diazepam dosage for mild sedation? (2)
0. 1-0.5 mg/kg orally one hour before appointment | * given AT the clinic
52
Diazepam dosage for children?
weight * 2 = number of drops
53
What advantages does midazolam have over diazepam? (4)
- starts at 20 mins (greater amnesic effect and shorter letency time) - twice as powerful - shortest halflife (1-4 hrs)
54
Dosage of midazolam for mild sedation?
- 0.5mg/kg single dose 20-30 mins before treatment
55
Deep sedation midazolam indications?
Patients with little to no cooperation (rare in dentistry)
56
How do we administer benzodiazepines for deep sedation? which one?
MIDAZOLAM intranasaly
57
Action of midazolam intranasal?
fast: 10-15 mins
58
Dosage of midazolam instranasal?
0.2-0.5mg/kg
59
Nitrous oxide mild sedation induction time?
2-3 mins
60
Nitrous oxide mild sedation recovery time?
3 mins
61
Nitrous oxide mild sedation therapeutic index?
narrow
62
Nitrous oxide mild sedation absorption and elimination?
pulmonary
63
Nitrous oxide effects? (2)
analgesic and sedative
64
Nitrous oxide mild sedation advantages? (4)
- FAST and gentle - staggered administration - short recovery time - no injection
65
Nitrous oxide mild sedation disadvantages? (4)
- small therapeutic index - cost of equipment - monitoring oxygen concentrations (should not be less than 30%) - nausea and vomiting
66
Nitrous oxide mild sedation indications? (5)
- children with anxiety - semi-cooperative children - phobia of local anesthesia - increased vomiting reflex - physically handicapped
67
Nitrous oxide contraindications?
- breathing problems: sinusitis | - non-response capacity: mentally handicapped, very young children
68
Nitrous oxide technique: (4)
- start with 85%02 and 15% N2o for 2-3 mins - increase 5% at intervals - mixture >65% o2 and = 35% n2o - when done, administer 100% O2 for 5 mins
69
20% concentration of nitrous oxide produces.. (2)
Paresthesias pleasant sensation
70
40% concentration of nitrous oxide produces.. (2)
Good pain tolerance patient collaboration
71
40-70% concentration of nitrous oxide produces.. (5)
- high psychosedation - loss of verbal contact - uncontrolled movements - amnesia - spasms

Peds III (9 decks)

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