SPECIAL CARE inhalation sedation Flashcards
(30 cards)
what is conscious sedation?
producing a state of depression of CNS during which verbal contact with pt in maintained throughout
what are the clinical effects of benzodiazepines as the dose increases?
anxiolytic
anticonvulsant
slight sedation
reduced attention
amnesia
intense sedation
muscle relaxant
general anaesthesia
why are benzodiazepines used for a premed?
they can act as an anxiolytic
what are the types of conscious sedation routes?
inhalation
intravenous
oral
intranasal (not widely available)
what are the ‘standard’ conscious sedation techniques available?
inhalation sedation on its own
IV sedation with single drug (midazolam) by a single route
oral sedation with a single drug by a single route
intranasal midazolam
what is the reversal agent for midazolam sedation?
flumazenil
what drug is used for inhalation sedation?
nitrous oxide and oxygen
how is IHS delivered?
as a gas via nose piece mask
what strength of sedation, in general terms, is IHS?
mild sedation - for mild anxiety
what must the pt be able to do for IHS to work?
breathe through nose
what effects does IHS have?
anxiolytic
analgesic
what is hypnotic suggestion?
reassuring and encouraging pt throughout the period of sedation and tx
describe nitrous oxide?
inhaled gas
sweet smelling
colourless
heavy
sometimes called laughing gas
what is Entoxon?
nitrous oxide used in ninewells for women in labour/ dislocations being popped back in
50/50 nitrous oxide and oxygen
how is nitrous oxide given?
starts with 100% oxygen for 1-2 minutes - flow rate 5-6 l/min
let pt settle and get used to mask, check for leaks and bag inflation
introduce nitrous oxide in increments, reach for 1-2mins
usual amount for adults is at least 50%
what is the MAX dose of nitrous oxide?
70% with minimum dose of 02 30%
properties of nitrous oxide?
rapid onset of action (3-5mins)
crosses the blood-brain barrier rapidly
rapid elimination
no significant metabolism by kidneys/ liver
not stored in tissues
NO hangover effect
what equipment is used for IHS?
RA machine
gas cylinders/ piped gas
scavenging
monitoring for staff
how do you read the RA machine?
it will read as the percentage of O2
what colour are the pipes for IHS?
white - oxygen
blue - nitrous
what is a scavenging system?
leads to a fan to expel gas outside
indications of IHS?
mild anxiety
patient not suitable for IV/GA
pt has a needle phobia
straightforward dental tx
IHS considerations?
able to co-operate
age
learning disability/ cognitive impairment
ability to tolerate mask
mask may impede access to anterior teeth
IHS contraindications?
generally safe and well tolerated
- COPD
- recent eye/ ear surgery
- mask intolerance
- pregnancy
- vit B12 deficiency
- methotrexate interaction
- chemo
