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BDS4 CDS Sedation Symposium > Sedation and SCD > Flashcards

Sedation and SCD Flashcards

1
Q

SCD for

A

those with a disability or activity restriction that directly or indirectly affects their oral healthy

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2
Q

problems with providing dental tx to SC pts

A
  • Communication
  • Anxiety
  • Moving target
  • Perception of reality
  • Previous experience

Often the same as providing medical care

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3
Q

2 common issues for SC pts getting dental tx

A

involuntary movements

learning difficulties (congenital or acquired)

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4
Q

duration of IV drug operating window approx.

A

40mins

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5
Q

5 possible congenital movement disorders

A
  • Muscular dystrophy – slight concern on airway
  • Cerebral Palsy
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Huntingdon’s Chorea – often has a learning difficulty association, tricky
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6
Q

possible acquired movement disorder

A

due to head injury

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7
Q

3 aspects in assessment needed for management of movement disorder

A

mental and physical status

anxiety

pain experience

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8
Q

possible causes of learning difficulties in SC pts

A
  • Congenital
    • Syndromic
    • Non-syndromic
  • Acquired
    • Trauma
    • Infection
    • CVA
    • Alzeheimer’s – often Elderly, additional complication e.g. drug metabolsim
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9
Q

3 assessment aspects for SC pts with learning difficulties

A
  • Will behavioural management be possible?
    • Many patients can be treated with TLC
  • Is pharmacological management needed?
  • Sedation or GA or both
    • Patient understanding
    • Patient’s pain experience
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10
Q

most important aspect of assessment for all SC pts

A

GET TO KNOW THE PT

what they do/don’t understand

triggers

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11
Q

consent key points

A

Adult Incapacity Act (2000) Scotland

No one else can give consent for adult to have treatment

  • If not competent to give consent
    • Medically qualified or appropriately trained dentists
    • can complete form allowing treatment
    • Lasts up to 36 months
  • Patient competent to consent but can’t write.
    • Not covered by legislation
    • Verbal consent document in notes
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12
Q

4 concious sedation technqiues

A
  • Inhalational N2O
  • Intravenous - midazolam
  • Oral sedation with midazolam (drink), can also get premed (milder)
  • Transmucosal
    • Intranasal
    • sublingual
    • rectal
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13
Q

7 considerations for choice of sedation technique

A
  • Patient co-operation
    • None ->GA
    • Good -> IHS, but need them to stay still and breathe through nose – challenge
  • Degree of anxiety
  • Dentistry required
    • Extremely invasive – IV, won’t remember
    • Upper central operated on – nose piece for inhalation may inhibit?
  • Skills of the dental team
  • Patient’s previous experience
    • Successful tx of sedation in past, likely go for that again
  • Facilities available
    • Hospital environment better in more complex pt, just in case
  • Anaesthetist required?
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14
Q

inhalation sedation

consists of

A

Safe technique

  • Nitrous oxide and oxygen combination through nasal hood
  • Mild anxiety
  • Rapid – both sedation and recovery
  • Sedated before injection – good for needle phobia
  • Flexible – can titrate, turn off on demand

need to be able to

  • Nasal breathing when mouth open.
  • Understanding Behavioural management
  • Cooperation
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15
Q

IHS for

A

mild anxiety only

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16
Q

IHS pt need to (3)

A
  • Nasal breathing when mouth open.
  • Understanding Behavioural management
  • Cooperation
17
Q

3 adv of IHS

A
  • Useful for anxiety relief
  • Rapid recovery
  • Flexible duration
18
Q

3 disadv of IHS

A
  • Keeping nasal hood in place
  • Less muscle relaxation (not as deep) (need pt stillness)
  • Coordination of nasal breathing when mouth open
19
Q

IV sedation where

A

cannula in back of hand od antecubital fossa

20
Q

3 techniques for IV sedation

A
  • Midazolam (majority)
  • Propofol – anaeshtestic agent at correct level becomes sedation, pump – adv pump off recover quickly, discharge quicker than midazolam
  • Multiple agent - deeper sedation, not allowed in UK for conscious sedation
21
Q

5 safety considerations for IV sedation to consider prior

A
  • Swallowing
  • Airway (needs to be stay patent)
  • Liver (metabolism of drug)
  • Medication interactions – check BNF
  • ASA
22
Q

3 adv of IV sedation

A
  • Good sedation achieved (deeper than IHS)
  • Less cooperation needed – need to get cannula in but after that fine
  • Muscle relaxation (can stop involuntary movements)
23
Q

5 diadv of IV sedation

A
  • Baseline readings
    • BP, pulse oximeter, resp count but if pt uncooperative and unable to get them, need to consider pt health as a whole and your experience before proceeding
  • IV Cannulation required
  • Assessing sedation level
    • can be hard, may need hand signs/blinking etc, establish before
  • Behaviour during recovery
    • get upset, challenging after tx
  • Efficacy swallowing
    • vital; if pt cannot swallow don’t want to put a drug in that decreases the swallowing reflex further
      • check how they eat diet before – do they need soften food? Swallowing risk on MHx? CONCERN for IV
24
Q

process for oral sedation

A
  • Baseline recordings and pulse oximeter on
  • Midazolam pull up 20mg, get them to drink in front of them
  • Same safety as IV – aim is as sedated as IV but oral
    • NOT PREMED – small dose benzodiazepine (diazepam or temazepam??) taken 1hr before dental appt, mild sedative to get them in
  • 30mins to take action from drinking
  • Bolus
    • not as good as IV as not adjustable
    • unpredictable
25
Q

intranasal sedation

A
  • V concentrated midazolam in a syringe with atomiser at end of syringe
  • Squirt up nose
    • Fine mist attaches to nasal mucosa
  • Popular
    • No first pass metabolism
      • More reliable
    • No waiting for it to be absorbed through gut
      • 7 mins for nasal mucosa
    • No inital cannulation
26
Q

4 adv of intranasal sedations

A
  • Avoid cannulation
    • (not completely – once sedated, need to put cannula in so have easy access in case need to reverse in oversedation)
  • Can make induction more pleasant
  • Better cooperation
  • Better future behaviour
27
Q

6 disadv of intranasal sedation

A
  • Baseline readings
  • Bitter taste / stinging
  • Lag time
  • Untitrateable
  • Difficulty in monitoring level of sedation
  • Behaviour in recovery
28
Q

possible outcomes for sedation pts

A

All needed treatment carried out

  • Some treatment can be carried out
    • Precision drilling not possible if the pt can move slightly
    • Need to remain conscious
      • XLA maybe easier than filling
      • Exam, Scale and polish
        • Can be essential – can assess further tx needed and plan
          • Avoid unnecessary GA
    • Refer to GA for treatment
  • Other treatments
    • E.g. cannula in for sedation – get bloods
29
Q

tx planning for possible sedation pts

A
  • Pre sedation exam may not be possible
  • Ability to cope
  • Complicated treatment?
    • Maintenance in future
  • Treat patient not the carer
  • Use sedation because of clinical need
30
Q

maintenance of oral hygiene considerations for SC pts

A
  • Will patient allow oral hygiene?
  • Are carers interested in providing oral hygiene?
  • Are the carers capable of providing oral hygiene?
31
Q

GA or sedation?

A
  • Safety
    • Controlled Airway with GA
    • Difficult intubation
  • Co-operation
  • Waiting lists and access to services
  • Pain
  • Medical history
  • Still a need for GA

BDS4 CDS Sedation Symposium (8 decks)

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