Sedation course Flashcards
What don’t the sedation guidelines define?
Regimen selection criteria, guarantee success
What are the NPO guidelines for sedation?
Clear liquids- 2hrs; human milk- 4hrs; infant formula- 6hrs; nonhuman milk- 6hrs; light meal- 6hrs
Monitoring requirements for moderate sedation?
parenthesis answer is for deep sedation
-Personnel should be trained in PALS (1 level higher is trained in PALS)
-Responsible practitioner - should be skilled in obtaining vascular access (skilled in obtaining vascular access)
Monitoring- ECG and capnography recommended (ECG and capnography required)
Other equipment- suction equipment, adequate oxygen source/supply (both of these + defibrillator required)
Documentation- recorded every 10 min (recorded every 5 min)
Difference between single-operator and two operator models
Single- dentist administers the medication and performs the procedure
Two- anesthetist administers the medication
Requirements for sedation in Ohio
-Documentation of completion of post-doctoral training program
-Current PALS
-Medical history form, sedation record
-Drug control program
-Proof of permanent residence in OH
-Properly equipped facility checklist
Ohio definition of conscious sedation
-Minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command, caused by pharmacologic or non-pharmacologic method or a combination thereof
-should carry a margin of safety wide enough to render unintended loss of consciousness unlikely
site visits for sedation
Prior to issuing sedation license, on-site evaluation of facility equipment, personnel, conscious sedation techniques,
Limitations of sedation license OH
-No administration of ultra-short acting barbiturates, propofol, perenteral ketamine
-Any other method that would render the patient deeply sedated/generally anesthetized
-Unless he/she holds a valid general anesthesia permit
Anatomic differences for pediatric pts vs. adults
-Proportionally larger occiput
-Smaller diameter airway (increases resistance)
-High metabolic oxygen demand
-Excess adipose tissue on neck and check (decreases lung compliance)
What critical age is listed in our literature for sedation above which are less significant physiologic changes
2 years old
- gastric pH reaches adult values by 2
-1-2 yrs all isoenzyme activites are similar to those of adults
-tubular reabsorption does not reach adult levels until age 2
The most common potential sedation-induced life-threatening events involve which body system?
Respiratory system
Which of the following monitors is required for deep sedation but not for moderate sedation?
Capnography and ECG
Practitioners of sedation must have the skills to rescue the patient from a deeper level than that intended for the procedure
True
According to the AAPD sedation best practice guideline, what is the minimum fasting period of consuming cow’s milk or orange juice with pulp?
6 hrs
What is the recording interval for documenting vital signs during moderate sedation?
Every 10minutes
What is the recording interval for documenting vital signs during moderate sedation?
every 5 min
Which of the following is not a characteristic of restrictive lung disease in obese children?
-increased airway resistance
-shallow, rapid breathing
-GREATER OXYGEN RESERVOIR
-increased risk of atelectasis
Significance of RSV infection in airway assessment for sedation
-associated with long-term respiratory morbidity, recurrent wheezing, asthma, decreased lung function and possible allergic sensitization
ASA class III physical status, URI, obesity and history of OSA/snoring is associated with which sedation outcomes?
Increased probability of failing sedation approximately 2x as often as not having these risk factors
Temperament associated with successful sedations
-higher levels of self-control
-lower levels of activity
-more outgoing
Children with which ASA classification are suitable candidates (in terms of medical condition status) for pediatric dental sedation?
-ASA I
-ASA I, II****
-ASA I, II, III
-ASA I, II, III, IV
RSV hospitalization before which age is associated with long term respiratory morbidity, such as recurrent wheezing, and asthma, decreased lung function, and possibly allergic sensitization?
3 years old
Obese patients require higher doses of sedative to achieve the same level of sedation
False
Why is tonsil size an important selection criterion for pediatric dental sedation?
the ability to maintain airway patency is potentially compromised in children with large tonsils
