Special Care And Sedation

Question 1

What common special care patient often requires sedation?

Answer 1

Those with involuntary movements

Those with learning difficulties
- congenital or acquired

Question 2

What movement disorders may someone present with?

Answer 2

Congenital
- muscular dystrophy
- cerebral palsy
- MS
- Parkinson’s

Acquired
- head injury

Question 3

How begin to manage a patient with involuntary movements?

Answer 3

Assessment of

• mental and physical status
• anxiety
• pain experience

Question 4

What consent is needed?

Answer 4

Written and signed consent must be done for sedation

After section 47

Question 5

What influences choice of sedation technique

Answer 5

Co-operation

Degree of anxiety

Dentistry required - access

Skills of dental team

Previous experience

Facilities

Allergy

Question 6

Advantages of inhalation sedation?

Answer 6

Useful for anxiety relief

Rapid recovery

Flexible duration

Question 7

Disadvantages of inhalation sedation

Answer 7

Keeping nasal hood in place

Less muscle relaxation

Coordinating nasal breathing when mouth is open

Question 8

Advantages and dadv of IV sedation

Answer 8

Good sedation
Less cooperation needed
Muscle relaxation

Baseline readings
IV cannula needed
Assess sedation level
Efficacy swallowing
Behaviour during recovery

Question 9

Advantages of oral/transmucosal sedation

Answer 9

Avoid cannula
Can make induction more pleasant
Better cooperation
Better future behaviour

Question 10

Dadv of transmucosal sedation?

Answer 10

Bitter taste / stinging
Lag time
Unntitrateable
Difficulty monitoring sedation level

Question 11

What is remimazolam?

Answer 11

New sedative drug undergoing clinical trials

Benzodiazepine ring + methyl ester molecule

• rapid breakdown and onset
• 7-11 min elimination half life vs 1.5-2 hours Midazolam