Sedation Flashcards
What is conscious sedation?
Depression of the central nervous system
Patient remains conscious, retained protective reflexes and understands and responds to verbal commands.
What are the standard sedation techniques for children (under 12), young adults (12-16) and adults?
Children and young adults - inhalation sedation with nitrous oxide/ oxygen
Young adults and adults - intravenous sedation with midazolam
What are indications for sedation?
Dental anxiety and phobia
Prolonged traumatic dental procedures
Medical conditions aggravated by stress
Medical or behavioural conditions affecting the patients ability to cooperate
Special care requirements
Why should an assessment be carried out on a separate day to sedation?
To give the clinician sufficient time to obtain and fully consider all of required information and allow for effective treatment planning
To give patient time to fully consider options (consent purposes)
Examples of factors which may affect a patients suitability for sedation?
MH- patients prescribed and non prescribed drugs (check for interactions/ adverse effects)
ASA score - can only treat score 1 and 2 in primary care
What is involved in a patient sedation assessment:
To determine the patients suitability for sedation and establish a treatment plan
Thorough MH, SH, DH, sedation history
Record patients ASA score
Oral exam and treatment plan
Explore all anxiety management techniques
Ensure sedation is justified (principle of minimal intervention), document and explain procedure to patient
Record blood pressure, oxygen saturation and heart rate
What is required for consent for conscious sedation?
Obtain valid written consent prior to administration of sedative drugs
Begin consent at assessment appointment, discuss proposed treatment/ proposed technique/ risks and benefits of treatment. Provide written information of this.
What is the advice regarding fasting, in terms of conscious sedation?
No indications for fasting- although avoid alcohol and large meals.
What is the advice regarding patient escort?
For adults receiving IV sedation and under 16s receiving inhalation sedation:
Ensure that a responsible adult (capable of looking after the pt, unaided) is present and accompanies the pt home after treatment.
Should travel home by car/ taxi not public transport
What can be given as premedication and when would this be prescribed?
Low dose benzodiazepine can be given as oral premed to assist with sleep the night before Tx or aid an anxious patients journey under close supervision to Tx facility.
This can be used as standalone anxiety management or can be followed by sedation
Does administering oral premed affect the consent process?
Yes- premedicated patients cannot give valid consent- ensure written consent has been obtained previously
What is the effects of other drugs on midazolam? Which drugs in particular have an effect on midazolam?
Almost all drugs increase the sedative effect of midazolam
Esp alcohol, opioids, erythromycin, antidepressants, antihistamines, antipsychotics, recreational drugs
What is ASA classification
ASA 1 - normal, healthy patient
2 - mild systemic disease
3 - systemic disease which is not incapacitatiting
4 - a patient with incapacitating systemic disease that is a constant threat to life
5 - moribund patient, not expected to live >24 hours
6 - brain dead for organ donation
Which ASA classifications can be treated in primary and secondary care?
ASA 1 and 2 - primary
3 and 4 - secondary care
What are pharmacodynamic interactions of benzodiazapeine?
Antidepressants + BDZs
Antihypertensives + BDZs
Interaction with drugs which have a similar/ antagonistic effects/ side effects
What are pharmacokinetic interactions?
One drug alters the absorption/ distribution/ metabolism and thereby, reduces the amount available of other drug
Not predictable
What ASA classification is pregnancy?
ASA 2
What is the discharge criteria for a patient after sedation?
Patient is orientated in time/ place/ person
Vital signs are stable and within normal limits for the patient, respiratory status not comprimised
Pain and discomfort have been addressed
Homeostasis achieved
Cannula has been removed
Escort present and travel arrangements made
Written post op instructions given to patient and escort
What are some complications of cannulation?
Venospasm
Extravascular injection
Intra arterial injection
Haematoma
Fainting
What are some complications of IV sedation?
Hyper responders
Hypo responders
Paradoxical reactions
Oversedation
Allergic reactions
How is oversedation managed?
Stop procedure
Try to rouse patient
ABC
If no response, reverse with flumazenil 200ug then 100ug increments at minute intervals
Watch for 1-4 hours
How is respiratory depression managed?
Check oximeter
Stimulate patient
Supplemental oxygen - nasal cannula 2 litres per minute
Reverse with flumazenil
How is an allergy to IV sedation managed?
Do not reverse with flumazenil - this is in the same drug family as benzodiazepine therefore, will make reaction worse.
Manage as if not sedated
How is IS sedation achieved?
Nitrous oxide titrated with oxygen, delivered through nasal hood (patient must be able to breathe through nose alone- not mouth, with mouth open).
