Special Care & Conscious Sedation Flashcards
1
Q
How can sedation be useful for patients with cerebral palsy?
A
sedation can stop uncontrolled movements for 45-60 minutes.
2
Q
How must consent be considered for special care patients attending for sedation?
A
- must be the patient giving consent
- verbal consent must be documented in notes
- AWI
- form by medically qualified or appropriately trained dentist
- lasts for up to 36 months
3
Q
What influences the choice of sedation technique for special care patients?
A
- patient cooperation
- degree of anxiety
- dentistry required
- skill of dental team
- patient’s previous experience
- facilities available
- anaesthetist required
4
Q
What are the advantages and disadvantages of inhalation sedation for special care patients?
A
- advantages
- useful for anxiety relief
- rapid recovery
- flexible duration
- disadvantages
- keeping a nasal hood in place
- less muscle relaxation
- coordination of nasal breathing and open mouth
- not ideal for special care patients
5
Q
What are the advantages and disadvantages of intravenous sedation for special care patients?
A
- advantages
- good sedation required
- less cooperation needed
- muscle relaxation
- disadvantages
- baseline readings
- IV cannulation required
- assessing sedation level
- behaviour during recovery
- efficacy swallowing
- increased risk
6
Q
What drugs can be used for intravenous sedation
A
- midazolam
- propofol
- paediatrics
- multiple agents
7
Q
What are the advantages and disadvantages of oral and transmucosal sedation?
A
- advantages
- avoids cannulation
- must be cannulated afterwards
- safety measure for reversal drug
- can make induction more pleasant
- better cooperation
- better future behaviour
- avoids cannulation
- disadvantages
- baseline readings
- bitter taste/stinging
- lag time
- 7 minutes delivered nasally
- untitrateable
- difficulty monitoring sedation levels
- behaviour in recovery
- good for autistic patients
- atomiser used to spray midazolam
- highly concentrated
8
Q
How is it assessed whether a special care patient is more suitable for general anaesthetic or sedation?
A
- safety
- controlled airway with GA
- difficult intubation
- cooperation
- can use intranasal initially
- waiting lists and access to services
- pain
- medical history
9
Q
What is remimazolam?
A
- sedative drug with shorter half-life
- benzodiazepine ring + methyl ester molecule
- rapid breakdown and onset
- broken down by tissue esterase
- reduced recovery time
- better for medically compromised
- liver problems
- short distribution half-life
- 0.5-2 minutes
- terminal elimination half-life
- 7-11 minutes
