Sedation

Question 1

what is the medicine administered in IV sedation

Answer 1

midazolam

Question 2

what is the medicine administered in inhalation sedation

Answer 2

nitrous oxide

Question 3

what is the definition of sedation

Answer 3

technique in which the use of a drug produces a state of depression in the CNS

Question 4

name three complications of cannulation

Answer 4

venospasm
extravascular injection
haematoma
fainting

Question 5

what is venospasm and what is it associated with

Answer 5

veins collapsing at attempted venepuncture
caused by poorly visible veins

Question 6

what is extravascular injection and what problems can this cause

Answer 6

active drug is put into interstitial space and not a vein
causes delayed absorption of drug

Question 7

what is a haematoma

Answer 7

extravasation of blood into soft tissue due to damage of vein walls

Question 8

name five complications of drug administration

Answer 8

hyperresponders
hyporesponders
paradoxical reactions
oversedation
allergic reactions

Question 9

what is the average dose of midazolam given

Answer 9

5-6mg

Question 10

why may patients be hypo-responders to sedation

Answer 10

cross tolerance from taking recreational drugs
idiopathic

Question 11

what is the maximum threshold of midazolam you should give before calling it a day

Answer 11

10mg in general practice
15mg in hospital setting

Question 12

side effects of midazolam are increased in patients on what

Answer 12

opioids

Question 13

what are paradoxical reactions

Answer 13

patients don’t sedate - they may appear hyper

Question 14

name three effects that occur with oversedation

Answer 14

loss of responsiveness
respiratory depression
loss of ability to maintain airway

Question 15

what is the reversal drug for midazolam

Answer 15

flumazenil 200mg

Question 16

when an allergic reaction to midazolam occurs what should you do

Answer 16

do NOT give flumazenil (same family of drug)

Question 17

what is the elimination half life of midazolam

Answer 17

1-2 hours - so the drug can be in the system for 12 hours
must have someone chaperone them

Question 18

signs of nitrous oxide overdose

Answer 18

patient discomfort
giggling
nausea
loss of consciousness

Question 19

what is the treatment for nitrous oxide overdose

Answer 19

decrease nitrous oxide concentration by 10-15%
do not remove nosepiece in case of diffusion hypoxia

Question 20

what would determine the type of sedation you would use on a patient

Answer 20

patient cooperation
degree of anxiety
dentistry required
facilities available

Question 21

give two advantages and two disadvantages of inhalation sedation

Answer 21

rapid recover
flexible duration

keeping nasal hood in place
coordination of breathing nasally while mouth is open

Question 22

give two advantages and two disadvantages of intravenous sedation

Answer 22

good sedation achieved
less cooperation required

IV cannulation required (still a needle)
ability to swallow - if patient cannot swallow they cannot be sedated with IV

Question 23

what classification is used to assess patients who may require sedation

Answer 23

ASA

Question 24

name three contra-indications to IV sedation

Answer 24

COPD
hepatic insufficiency
pregnancy and lactation

Question 25

name three contra-indications of inhalation sedation

Answer 25

pregnancy blocked nasal airway COPD

Question 26

how do benzodiazepines work

Answer 26

act on receptors in CNS to enhance effect of GABA

Question 27

what allows benzodiazepines to attach to receptors in the CNS

Answer 27

benzine ring

Question 28

name three effects that benzodiazepines have

Answer 28

CNS depression and muscle relaxation decreased BP (due to muscle relaxing) increased heart rate (compensate for fall in BP)

Question 29

what is the preparation for midazolam for sedation and where is it metabolised

Answer 29

5mg/ kg metabolised in liver

Question 30

what are the 4 benefits of midazolam over diazepam

Answer 30

painless quicker onset quicker recovery more reliable

Question 31

what are the two cannulation sites for IV sedation

Answer 31

dorsum of hand antecubital fossa

Question 32

how often should NIBP measurements be taken during IV sedation

Answer 32

every 5-10 minutes

Question 33

how is a respiratory depression managed in IV sedation

Answer 33

talk/ shake patient head tilt/ chin lift 2ml/ min nasal canulae of O2 flumazenil

Question 34

how long after last increment of IV sedation is given does the patient have to stay

Answer 34

60 mins

Question 35

what two types of drug have pharmacodynamic interactions with benzodiazepines

Answer 35

antidepressants antihypertensives

Question 36

what vital signs are taken at a sedation assessment

Answer 36

heart rate BP oxygen saturation weight heught

Question 37

what is the maximum BMI score accepted for IV sedation

Answer 37

35

Question 38

what volume does the reservoir bag for inhalation sedation hold

Answer 38

2-3 litres

Question 39

what colour is the pipe for nitrous oxide delivery in inhalation sedation

Answer 39

blue

Question 40

what colour is the pipe for oxygen delivery in inhalation sedation

Answer 40

black

Question 41

name four pre-op instructions for inhalation sedation

Answer 41

have light meal before appointment children accompanied by competent adult adults accompanied for first session plan to remain in clinic for 30 minutes after treatment

Question 42

what should the flow for inhalation sedation be set to

Answer 42

5-6 litres per minute

Question 43

how is recovery achieved after inhalation sedation

Answer 43

gradually increase O2 by 10% per minute until 100% reached and administer for 2-3 minutes