Sedation - IV Assessment

Question 1

What is involved in a sedation assessment visit? (4)

Answer 1

confirms the dental treatment required

whether sedation is needed

the preferred technique of sedation.

informed consent and information regarding treatment and aftercare

Question 2

What are the benefits of having a sedation assessment at a separate visit? (3)

Answer 2

• Patient less anxious
• Gives patient time to make their decision with no anxiety/pressure.
• Allows assessment of physiology, pathology, psychology (baseline readings) to be recorded

Prerequisite to treatment for patients and dental team

Question 3

What aspects of social history are important for a patient undergoing a sedation assessment? (6)

Answer 3

• Occupation: important to ensure its appropriate to return to work the next day etc.
• Available Escorts = mandatory
• Alcohol habits
• Responsibilities - e.g children, carer for elderly as px cannot do this during recovery
• Transport home
• Age: sedation different for extremes of age

Question 4

What aspects of dental history are important for a patient undergoing a sedation assessment? (4)

Answer 4

• what is the nature of fear
  Any previous bad experience with dental treatment (is this the route on anxiety)
• General anxiety or Specific to a stimuli
• can provide anxiety questionnaire including MDAS-
• Any problem with Previous sedation / GA and the nature of the problems
• Symptoms: Acute or chronic
• What is the proposed procedure? useful when tx can be completed within 45 mins (not too complex)
  or when tx can be difficult to tolerate even when patient not anxious eg. some third molars

Question 5

Why is obtaining an accurate medical history important during sedation assessment?

Answer 5

almost all drugs increase the sedative effect of midazolam - drug commonly used for sedation

Question 6

What drugs interact with midazolam? (7)

Answer 6

• Alcohol
• Opiods
• Antibiotic - Erythromycin
• Antidepressants
• Antihistamines
• Antipsychotics
• Recreational drugs

Question 7

Define an ASA I patient.

Answer 7

Normal healthy px, non-smoker and minimal alochol

Question 8

Define an ASA II patient.

Answer 8

px with mild systemic disease

Question 9

Define an ASA III patient.

Answer 9

px with severe systemic disease which limits activity but not incapacitating

Question 10

Define an ASA IV patient.

Answer 10

px with severe systemic disease which is a constant threat to life

Question 11

Define an ASA V patient.

Answer 11

moribund px - not expected to live > 24 hours

Question 12

Define an ASA VI patient.

Answer 12

Px who is brain dead for organ donation

Question 13

Provide examples of px’s who are ASA II (7)

Answer 13

• Current smoker
• Pregnancy
• well-controlled epilepsy
• well-controlled asthma
• NIDDM (non insulin dependent diabetes mellitus)
• BP = 140-159/90-94 (borderline hypertension)
• Obesity (BMI 30 to <40)

Question 14

Provide examples of px’s who are ASA III (7)

Answer 14

• IDDM (insulin dependent diabetes mellitus)
• > 6/12 post MI
• > 6/12 post CVA (stroke)
• stable angina
• COPD
• BP = 160-199/95-114 (hypertension)
• BMI>40

Question 15

Provide examples of px’s who are ASA IV (5)

Answer 15

• unstable angina (chest pain at rest)
• < 3/12 post. MI or stenting
• < 3/12 post. CVA (stroke)
• severe COPD
• BP > 200/115 (very hypertensive)

Question 16

In what care setting can ASA I be treated in?

Answer 16

primary care

Question 17

In what care setting can ASA II be treated in?

Answer 17

primary care

Question 18

In what care setting can ASA III be treated in?

Answer 18

usually treated under anaesthetist led sedation in hospital

Question 19

In what care setting can ASA IV be treated in?

Answer 19

secondary care setting

Question 20

In what care setting can ASA V be treated in?

Answer 20

secondary care setting

Question 21

What is a common risk/side effect of sedation?

Answer 21

Respiratory depression

Question 22

What information do we need regarding a patient undergoing sedations asthma? (3)

Answer 22

• What drugs do they take for their asthma and how often?
• Have they been hospitalised? = severe
• Is it exacerbated by stress

Question 23

Define pharmacodynamic drug interactions.
is this predictable?

Answer 23

Interactions between drugs which have similar or antagonistic pharmacological effects or side effects

• predictable

Question 24

Provide 2 examples of drugs that have similar effects to benzodiazepines (sedatives)

Answer 24

• Antidepressants
• Antihypertensives

Question 25

Define pharmacokinetic drug interactions.
is this predictable?

Answer 25

One drug alters the absorption, distribution, metabolism or excretion of another drug, thereby increasing or reducing the amount of drug available to produce its pharmacological effects
- Not predictable

Question 26

Is sedation a tx option for pregnant women? (4)
Explain

Answer 26

Try to be avoided as it makes mother anxious

Theoretical risks!!
possible teratogenic (causes abnormality)

Possible Sedative effect on baby

Possible effect on Lactation – sedative agents present

Question 27

What medical conditions should we be cautious of when assessment px’s for sedation?

Answer 27

pregnancy
respiratory disease
those on medication(s)
psychiatric diseases

Question 28

What recordings are taken in the sedation assessment appointments? (4)

Answer 28

(Vital signs)

• HR
• BP: taken at initial assessment and then every 5 mins during sedation
• Oxygen saturation: taken at initial assessment and then every 5 mins during sedation
• BMI=weight (kg)/height(m2)
  Less than 18.5 = Underweight
  Between 18.5 - 24.9 = Healthy Weight
  Between 25 - 29.9 = Overweight
  Over 30 = Obese
  Weight cut off for sedation = BMI 35)