Sedation

Question 1

What does ASA stand for

Answer 1

Amercian Society of Anaesteologist of medical status

Question 2

ASA I and ASA II tx

Answer 2

done by trained sedation dentist

Question 3

ASA III

Answer 3

done in a hospital setting

Question 4

ASA I

Answer 4

normal healthy person
non smoker
minimium alcohol

Question 5

ASA II

Answer 5

mild systemic disease - preg, well controlled asthma, epilepsy, diabetes
blood pressure - 140154/90-94

Question 6

ASA III

Answer 6

severe systemic disease - type 1 diabetes, stable angina, COPD, 6months MI and CVA
Blood pressure = 160-199/95-114

Question 7

ASA IV

Answer 7

severe systemic disease, constant threat to life
unstable angina
severe COPD
<6months MI and CVA
Blood pressure 200/115

Question 8

ASA V

Answer 8

moribud, not expected to survive operation

Question 9

ASA VI

Answer 9

brain dead, organs for dontation

Question 10

Vital signs to monitor during sedation

Answer 10

blood pressure
heart rate
O2 levels - pulse oximeter
weight - weight/height2

Question 11

Contraindications of sedation

Answer 11

severe uncontrolled systemic disease
severe physical or mental handicap
pyschaitric disorders
hypothyroidism
prep pts
COPD
spreading infection which could comrpomise airway

Question 12

Indications for sedation

Answer 12

pt with poor co-operation
mild learning difficutlies
cerbral palsy
Parkinsons
phobias/gagging
neddle phobias

Question 13

What drugs do sedation interact with

Answer 13

alcohol
opoids
erythomycin
recreational drugs
antidepressants
antihistamines
antipsychiotics

Question 14

Complications of sedation

Answer 14

sexual fantasy
allergic reaction
over sedation
hyop repsonders
hyper responders
fainting
haematoma
intra-arterial injection
venospasm
extravascular injection

Question 15

Indications of inhalation sedation

Answer 15

anxious
needle phobia
gaggers - nitrous oxide reduces gag reflex
medical conditions aggravated by stress
unaccompained but required sedation
liver problems

Question 16

Contraindications of inhalation sedation

Answer 16

common cold
severe COPD
first trimester of pregnancy
fear of mask
tonsillar/ adenoid enlargement

Question 17

Advantages of inhlation sedation

Answer 17

no amnesia
no injection
rapid onset and peak
quick revoery
few side effects

Question 18

Disadvantages of inhaltion sedation

Answer 18

equipement and gas expensive
requires to breathe through nose
space for equipment
not potent
staff can become addicted to it

Question 19

What colour os oxygen cylinder

Answer 19

black

Question 20

what colour is NO2

Answer 20

blue

Question 21

Equipment for inhalation sedation

Answer 21

gas cyclinders
pressure reducing valves
flow control meter
reservoir bag
gas delivery hoses
nasal hood
waste gaas scavenging system

Question 22

Pre op insturctions before inhalation sedation

Answer 22

light meal before
meds as normal
children accompained by adult
adults accompained for 1st sedation appt
no alcohol
sensible clothing

Question 23

Signs of adequate inhaltion sedation

Answer 23

relaxed and comfortable
pt awake
reduced blink reflex
verbal contact maininted
decrease reaction to painful stimuli
decrease in spontaneous movement

Question 24

Oversedation signs

Answer 24

nasuea/vomiting
mouth closes repeatdely
decreased co-operation
uncontrollable laughter/tears
loss of consciuness
incoherent speech
sluggish response

Question 25

Sites for cannulation of iv sedation

Answer 25

dorsum of hand antecubital fossa

Question 26

Vernil's sign

Answer 26

drooping of eyelids

Question 27

Eve's sign

Answer 27

touch nose with finger

Question 28

Midazolam

Answer 28

5mg/5ml (1mg/1ml) pH 3.5 - allows to be soluble when injected more potent and rapid metabolised in liver and extra hepatic metabolism in bowel

Question 29

What can unsedate a pt if required

Answer 29

flumazenil - benzodiazepine antagonsit 200mcg then 100mcg every 60 secs

Question 30

4 main valves in the hearrt

Answer 30

tricuspud pulpmnary mitral aortic

Question 31

Pulmonary circulation

Answer 31

oxygen depleted blood leaves the ringth ventricle reached the lung and replinshed with oxygen and back to left atrium

Question 32

Systemic circulation

Answer 32

sino atrial node sends eletrical signals through atria causing contraction pushing blood into ventricles incrseased pressure pushes bi and tricuspic vavlves open electircal activity reached avn and action poteitnals trasferred along purkinje system

Question 33

The cardiac cycle

Answer 33

atrial systole ventricular systole verntricular diastole

Question 34

Ventricular systole

Answer 34

isovolumetirc ventricular contraction - contraction but no change in volume, increase in pressure

Question 35

Ventricular diastole

Answer 35

isovolumetric relaxation - volume does not change and ventricles passively fill up

Question 36

What is starling's law

Answer 36

related to end diastolic volume higher it is the higher the stroke volume

Question 37

what is the afterload

Answer 37

the force the heart has on systole the pressure needed to pump against arterial blood pressure and total pherpieral resistance

Question 38

What is dead space

Answer 38

air inhaled but does not reach the alveoli

Question 39

Anatomical dead space

Answer 39

air breathed in but stays in conducting zone (no active gas trasnfer)

Question 40

Alveolar dead space

Answer 40

due to perfusion of alveolus

Question 41

Haemogloblin

Answer 41

globular protein - 2 apha and 2 beta chains 4 haem groups within a porphyrin ring

Question 42

in sedation does nitrous oxide bind to haem

Answer 42

does not bind to haemogloblin and carried in blood

Question 43

How is carbon dioxide transported

Answer 43

by erythrocytes and blood plasma

Question 44

Hypocapnia

Answer 44

what should physiologically drive breathing detected by central chemorecptors

Question 45

Hypoxia

Answer 45

how breathing is driven in COPD

Question 46

Hypoxic

Answer 46

decrease in oxygen reaching alveoli or decrased amount of oxygen diffusion into blood

Question 47

Anaemaia hypoxia

Answer 47

decrease in oxygen in blood due to low haem

Question 48

Stagnany (ischamic) hypoxia

Answer 48

low blood flow decreasing oxygen

Question 49

cytotoix hypoxia

Answer 49

low utilisation of oxygen by cells themselves

Question 50

Cyanosis

Answer 50

>5g of deoxygenated haem/ 1 litre of blood

Question 51

Central cyanosis

Answer 51

affects the whole body, decrase in oxygen to blood

Question 52

What is central cyanosis caused by

Answer 52

low atomospheric oxygen pressure decrseased airflow in airways decreased oxygen diffusion into blood decreased pulmonary blood flow shunting

Question 53

Peripheral cyanosis

Answer 53

decreased oxygen delivery to localised and peripheral body part decreased blood flow to tissues (stagnant hypoxia)