Sedation - Intro, monitoring Flashcards
1
Q
Valium
A
Diazepam
2
Q
Ativan
A
Lorazepam
3
Q
Halcion
A
Triazolam
4
Q
Versed
A
Midazolam
5
Q
Ambien
A
Zolpidem
6
Q
What kind of sedation is best for anxiety relief?
A
Enteral sedation
7
Q
What is a good route of sedation to use as premed for other routes?
A
Enteral sedation (oral/rectal)
8
Q
What is the worst kind of sedation for pharmacological restraint?
A
Enteral sedation
9
Q
What is pain?
A
That which hurts, is unpleasant
10
Q
Among pain, fear and anxiety, which one is a short-lived phenomenon?
A
Fear
11
Q
Which one out of pain, fear and anxiety disappears when danger or threat passes?
A
Fear
12
Q
Which out of pain, fear and anxiety is a learned response?
A
Anxiety
13
Q
Which one out of pain, fear and anxiety is anticipatory?
A
Anxiety
14
Q
Diminution or elimination of pain is known as..
A
Analgesia
15
Q
Elimination of sensation in one part of body
A
Local anaesthesia
16
Q
Topical application and regional injection of drug are forms of
A
Local anaesthesia
17
Q
Grades of sedation
A
Minimal Sedation < Moderate Sedation < Deep Sedation < General Anaesthesia
18
Q
In CA, what is the age of a patient at which they are given Pediatric Oral Conscious Sedation?
A
< 13 years
19
Q
Administration of an oral medication at dose that exceeds maximum dose recommended by FDA
A
Adult Oral Conscious Sedation
20
Q
3 things sedative modality is dependent on
A
- Patients degree of anxiety
- Clinician’s level of training
- The procedure
21
Q
Sort drugs used for anxiety relief in ascending order of morbidity
A
Nitrous oxide < Oral premedication < Parenteral premedication < Deep sedation < GA
22
Q
Goals of sedation
A
- Fear and anxiety relief
- Stress reduction
- Improved pain control
- Enhanced patient cooperation
23
Q
Is Anaesthesia indicated in gagging?
A
Yes
24
Q
Indications for sedation
A
- Anxiety or fear in adults
- Young children
- Mental or physical disability
- Medically compromised patient
- Extensive invasive procedure
- Extended care during one appointment
- Gagging
- LA problems
25
Is sedation indicated in anxious or fearful children?
No
26
Lost the different techniques of sedation
1. Iatrosedation
2. Inhalation
3. Oral
4. Rectal
5. Intramuscular
6. Intravenous
27
2 types of rectal sedation
1. Sublingual
| 2. Intranasal
28
Types of intramuscular sedation
1. Subcutaneous
| 2. Submucosal
29
Is Local Anaesthesia part of sedative regimen?
Yes
30
What % of patients are terrified of dental treatment?
3%
31
What % of patients are very afraid of dental treatment?
4%
32
What % of patients are somewhat afraid of dental treatment?
13%
33
In patients with dental anxiety, does LA work?
Yes, but only in >/= 50%
34
Est. Dental anxiety incidence in USA
16.4%
35
Country with least dental anxiety incidence
Denmark
36
Country with highest dental anxiety
The Netherlands
37
Legislative issues in sedation
1. Restricted vs exempt techniques
2. Training requirements
3. Performance requirements
4. Maintenance requirements
38
Standards vs Guidelines vs Statements
Standards are the only things to be strictly followed in order to maintain lawful activity
39
Most up to date guidelines among ADSA, ADA and ASA
ASA - last amended 10/2010
ADA - 10/2007
ADSA - 1988
40
What all do you monitor during anaesthesia?
Oxygenation
Ventilation
Circulation
Temperature
41
According to ADA, for minimal and moderate sedation, how do you evaluate an ASA I patient?
Review current medical history
42
According to ADA, for minimal and moderate sedation, how do you evaluate an ASA II patient?
Review current medical history
43
According to ADA, for minimal and moderate sedation, how do you evaluate an ASA III patient?
Medical consult
44
According to ADA, for minimal and moderate sedation, how do you evaluate an ASA IV patient?
Medical consult
45
In what kind of sedation does the ADA not mandate the use of pulse oximetry to monitor oxygenation?
Minimal sedation
46
What should be done in both minimal and moderate sedation patients to monitor oxygenation, according to the ADA?
Colour of mucosa, skin or blood must be evaluated continually
47
ADA - only chest excursions need be observed to monitor ventilation. What kind of sedation?
Minimal sedation
48
ADA - what more needs to be done to monitor ventilation in moderate sedation?
1. Auscultate breath sounds
2. Monitor end-tidal CO2
3. Verbal communication with patient
49
Difference between ADA circulation monitoring guidelines for minimal and moderate sedation
- continual evaluation of HR and BP in moderate - if unable to tolerate, note in time-oriented record.
- HR and BP - pre-, intra- and post-op readings noted in minimal sedation
50
During discharge, what two things should immediately be available in recovery area?
Oxygen and suction
51
Should monitoring be continued when anaesthetic is no longer being administered?
Yes. - oxygenation, ventilation and circulation.
52
When should you stop monitoring a patient who has undergone moderate or minimal sedation?
Only stop when patient is stable and ready for discharge.
53
What are the required contents of documentation?
1. Appropriate time-oriented reord
2. Names of all drugs, including LA
3. Monitored parameters
4. Pulse oximetry, RR, BP
5. Stable O, V and c before discharge
6. Postop instructions
54
How do you recognise deleterious trends during a procedure under anaesthesia?
Monitoring
55
How do you detect acute emergencies when patient is sedated?
Monitoring
56
How do you evaluate effect of the administered anaesthetic during a procedure?
Monitoring
57
Face validity
If you cannot detect a problem it cannot be managed.
58
What are the majority of emergencies during a procedure when a patient is sedated?
Respiratory, preventable.
59
Descending order of % of damaging events in malpractice claims
Respiratory > Cardiovascular > Equipment
60
What kind of respiratory event is becoming ever more dangerous in sedation?
Difficult intubation
61
What cause of respiratory event is becoming less relevant?
Inadequate ventilation
62
What are the most common causes of respiratory events?
Inadequate ventilation, esophageal intubation, difficult intubation
63
In what kind of sedation is a patients response purposeful to verb or tactile stimulation
MOderate sedation
64
In what kind of sedation is a pain stimulus required to elicit a response from the patient?
Deep sedation
65
In what kind of sedation is a patient unarousable even with a painful stimulus?
GA
66
Under which kinds of situation could intervention to maintain a patent airway required?
Deep sedation and GA
67
Methods of monitoring ventilation
1. Chest excursion
2. Reservoir bag movements
3. Auscultation of breath sounds
4. Capnography
68
Instruments/equipment used to monitor ventilation
1. Pretracheal stethoscope
| 2. End-tidal carbon dioxide detector
69
What instrument can quickly detect partial airway obstruction and foreign matter in the airway?
Precordial stethoscope
70
What is the pretracheal stethoscope also known as?
Precordial stethoscope
71
What all can you measure with a pretracheal stethoscope?
RR and indication of ventilatory depth
72
How long does the pretracheal stethoscope take to detect apnea?
34 sec
73
What is the major limitation of etCO2 detector?
Expensive
74
What is the ETCO2 detector great at doing?
1. Confirming ET tube placememt
| 2. Accurate assessment of ventilation
75
What are the stages of a capnogram?
Sea level - exhalation
Plateau level - alveolar plateau
Edge of plateau - end-tidal CO2
Cliff off plateau - inspiration
76
What is used to monitor O2 sat?
Pulseox
77
Methods of monitoring oxygenation
1. Visual inspection
| 2. Pulse oximetry
78
Is visual inspection useful while monitoring oxygenation?
No - poor sensitivity and high variability
79
Can you dependably detect cyanosis by visual inspection?
No - late detection - 5g/dL
80
What is a major concern during anaesthesia as far as oxygenation is concerned?
Oxygen delivery to peripheral tissues
81
How do you measure oxygen delivery to peripheral tissues?
Product of cardiac output and oxygen content in the blood
82
What does the pulseox do?
Rapid, continuous, noninvasive estimation of PaO2 hb
83
How do you figure out the relationship between saturation of hb with o2 and the partial pressures of o2?
Oxyhb dissociation curve
84
What is the safe level of O2 Sat?
95 +/- 4 %
85
Normal content of O2 in blood
20 mL/dL
86
How is O2 carried in blood?
1. Oxyhemoglobin
| 2. Dissolved in plasma
87
How many LED's does a pulseox have?
2 - visible red light and IR radiation
88
What is the wavelength of the visible red light LED in a pulseox?
660 nm
89
What is the wavelength of the IR Radiation LED in a pulseox?
920 nm
90
Reduced hemoglobin absorbs ______ light more
Visible red
91
Oxyhemoglobin absorbs ______ light more
IR Radiation
92
What are the 2 fundamental principles of Pulse Oximetry?
1. Differential light absorption
| 2. Increased light absorption by pulsatile blood flow compared with CT, Bone, venous blood etc
93
Basis of oximetry
Beer's law
94
Beer's law
The intensity of transmitted light decreases exponentially as the concentration of the substance increases
95
Does the pulse oximeter work on assumptions?
Yes - All pulses are arteriolar and all light passes through pulsatile beds with adequate normal hb.
96
Does the pulse oximeter take into account dyes?
no
97
Can Pulseox be used with nail polish?
no
98
Can pulseox be used in severely anemic patients?
no
99
Can pulseox be used when patient is constantly moving?
no
100
Can pulseox be reliably used when there is electronic interference?
no
101
Can pulseox be used when there is excessive ambient light?
no
102
Why would there be poor perfusion in peripheral areas?
1. Physical occlusion of blood flow
2. Vaso constriction
3. Hypotension
4. Venous congestion
5. Hypothermia
103
What specific intervals should BP be taken at during GA?
5 minutes
104
Methods used to monitor circulation
1. Pretracheal stethoscope
| 2. BP device
105
How do you detect arrhythmia in sedated patients?
Use pretracheal stethoscope
106
How do you detect changes in heart tone in sedated patient?
Pretracheal stethoscope
107
How is BP determined when using a BP device?
Listening to Korotkoff sounds
108
What happens when the cuff used to measure BP is too small?
BP overestimated
109
What happens when cuff used to measure BP is too big?
BP underestimated
110
What is the ideal width of the cuff used in a BP machine?
20% wider than diameter of the limb
111
Are manual or automatic devices better at detecting hypotension?
Automatic
112
Which one's faster at determining BP - manual or automatic?
Manual
113
Which one is sensitive to movement - manual or automatic BP device?
Automatic
114
In which patients do you place the BP cuff on forearm?
Obese patients
115
Where do you place BP cuff in obese patients?
Forearm
| Calf
116
When do you feel for radial pulse return while measuring BP?
When you cannot hear Korotkoff sounds
117
What do you do when you cannot hear Korotkoff sounds?
Feel for radial pulse return
118
What does radial pulse return signify?
It correlates with systolic pressure
119
When is ECG continuously displayed during sedation??
Patients with significant cardiovascular disease
120
What kind of ECG is used for arrhythmia detection?
3 lead ECG
| 5 lead ECG
121
2 instruments used to detect arrhythmia
1. Pretracheal stethoscope
| 2. ECG - 3 lead, 5-lead
122
What lead is used to take readings in 3 lead ECG?
Lead II
123
How do you detect ischemia in a sedated patient?
5 lead ECG
