Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Oral Sedation 732
Final Test
| Question | Answer |
|---|---|
| Define sedation. | calm the nervous, apprehensive individual |
| What is the goal of sedation? | calm with use of a systemic med without LOC |
| What is phychosedation? | management of fear and anxiety - iatrosedation (meds not used)and pharmacosedation |
| What is the goal of iatrosedation? | minimize the need for meds |
| Define iatrosedation? | relief of anxiety through the doctors chairside manner and communication |
| Name examples of psychosedation? | acupuncture, audioanalgesia, biofeedback, baced breathing, electronic (anesthesia/sedation) and hypnosis |
| What is the least likely route of administration to develop drug reactions? | PO |
| What are disadvantages to the oral route? | unreliable absorption, unable to easily achieve desired effect, prolonged action, unable to reverse the meds effect |
| How are oral meds titrated? | Impossible to titrate with CNS safety |
| Is topical effective in keratinized tissue? | no |
| KNOW What is the benefit to sublingual administration? | Avoids GI degration and first pass hepatic metabolism |
| Intranasal sedation is mainly used in what age group? Drawback. benefit. | peds, tastes bad/sneezing. bipasses hepatic circulation |
| What is the route for Scopolamine? | fentanyl - transdermal |
| What anesthetic technique is least used in dentistry? | IM |
| Why isn't SubQ used much in dentistry? | slow absorption |
| When is the onset of action of an IM? Injection site with the fastest absorption? Max ml's at site | 10", deltoid (gluts lack vascularity),4ml |
| How common are intralingual injections in dentistry? | never done |
| KNOW When are subcutaneous injections contraindicated? | When their is circulatory compromise |
| What are the advantages to inhalation sedation (nitrous) | Short latent period, titration possible, rapid recovery |
| What is the disadvantage to inhalation sedation (nitrous) | weak analgesia, nasal obstruction, pt cooperation needed, cost |
| What are the main disadvantages to IV sedation?q | Can't reverse in some cases, adverse effects are exaggerated |
| When is IV sedation used? | for the most fearful patients |
| What is anxiolysis | relief of anxiety d/t action on the limbic system, thalamus |
| Why are benzo's (ativan, xanax, etc), preferred over barbiturates ? | no hangover |
| What is chloral hydrate used for? | pediatric sedation, long half life 7-9 hours |
| What are histamine H1 blockers used for? give an example | allergy, nausea and sedation. Promethazine (phenergan and hydroxyzine) |
| What are the contraindications to histamine blockers? | liver dysfunction, pregnant |
| Name common opioid side effects | nausea, vomiting and postural hypotension |
| What happens to patient who take opioids who are not in pain? | dysphoria |
| What is the 3 pronged approach to managing acute pain? | remove cause, block impulses, activate pt's own analgesic mechanisms |
| How does a personality disorder affect analgesia? | unpredictable behavior |
| What happens to COPD patients with nitrous? Why? | may see steep decline in resp rate and depth. High O2 shuts down hypoxic drive. Nitrous is not contraindicated (use with caution) |
| What is the risk with perfluoropropane and sulfur hexafluoride? | can form bubbles in the eyes if I don't wait 8 weeks after perfluoropropane or 2 weeks after sulfur hexafluoride |
| Vomiting reflex with nitrous is usually seen in what age group? What med class helps? | kids, antihistamines (can't give without a class 2 license |
| Persistent mough breathing, spontaneous mouth breathing, poor verbal response, crying, laughing, loss of coordination are all effects of? | nitrous oversedation |
| When should nitrous recovery start? | asap - before the end of the procedure |
| What is tachyphylaxis? | rapid tolerance - assoc with nitrous |
| Does high O2 induction speed up nitrous effects if O2 is used 6-8 minutes before the nitrous? | No, but there is an increased risk of nitrous side effects |
| What test is used to monitor pt coordination after nitrous? What is the usual nitrous recovery time? | Trieger, 3-5 minutes |
| Class 1 anesthesia permit requirements for suction, O2, vitals | backup suction, backup O2, BP and P monitoring, Scavenging system (req by Board) |
| What is Corah's questionnaire? | anxiety test. score of 10-12 = anxiety |
| What should be recorded in a nitrous discharge entry? | Patient alert and oriented x3, sits up and walks without assist, no NV or dizziness |
| What level is tactile response, thought, coordination and airway in a minimally sedated patient? What % of nitrous? | respond normally to tactile stimulation, maintain own airway, modestly impaired thought and coordination. <50% |
| What level is tactile stimulation, thought and airway in a moderately sedated pt? What % of nitrous? | light tactile, purposeful thought with depressed conciousness,Maintains own airway, >50% |
| What is the level of tactile response, thought and airway in a deeply sedated pt? | responds to repeated or painful stimulation, depressed conciousness/ difficult to arouse. May need assistance to maintain airway. Ventilation may be inadequate. |
| What is the level of tactile response, thought and airway in a patient under general anesthesia? | will not respond to pain, unconscious, often need assist with airway and ventilation. Cardiovascular function may be impaired. |
| How many hours of instruction is required for a class 1 nitrous license? | 14 hours with a clinical part |
| What level is tactile response, thought, coordination and airway in a minimally sedated patient? What % of nitrous? | respond normally to tactile stimulation, maintain own airway, modestly impaired thought and coordination. <50% |
| What level is tactile stimulation, thought and airway in a moderately sedated pt? What % of nitrous? | light tactile, purposeful thought with depressed conciousness,Maintains own airway, >50% |
| What is the level of tactile response, thought and airway in a deeply sedated pt? | responds to repeated or painful stimulation, depressed conciousness/ difficult to arouse. May need assistance to maintain airway. Ventilation may be inadequate. |
| What is the level of tactile response, thought and airway in a patient under general anesthesia? | will not respond to pain, unconscious, often need assist with airway and ventilation. Cardiovascular function may be impaired. |
| How many hours of instruction is required for a class 1 nitrous license? | 14 hours with a clinical part, BLS, DMD |
| What is the requirement for enteral and or combination inhalation minimal sedation (class 2)? | BLS, 16 hours with clinic part, complete class 1, meet pre-requisites to teach control of pain and anxiety |
| What is the requirement for moderate sedation: enteral? | 24 hours + manage 10 cases |
| What is the requirement for moderate sedation : parenteral? | 60 hours + manage 20 patients |
| What class of license is required to give a dose of anxiolysis? | none |
| Which is safer a demand flow or a continous flow? | continous |
| How often should nitrous equipment be oiled? | never grease or oil - always dry |
| What is the pressure of a full nitrous tank? | 750psi |
| When does the pressure gauge drop in a nitrous tank? | when it hits 20% full |
| What is the pressure in an O2 tank? When does the pressure drop? | 2000psi, as soon it looses pressure (50% = 1000psi) |
| How long does a 6L flow last in an O2 tank? | 110 minutes |
| What is the most important safety feature of nitrous admin? | O2 driven. Will not work unless O2 tank has at least 30% full (600 psi, 33min)air. |
| At what pressure is nitrous administered? | 50psi |
| What is the stand that holds the nitrous/O2 called? | yolk stand |
| What are the 3 purposes of the reservoir bag? | Provides reserve air if patient inhales more than is being delivered, acts as a monitoring device in inhalation/exhale, can provide positive ventilation if pt has a mask on |
| What is the most common reservoir bag for adults. What is the range of bag sizes? | 3L, 1-8L |
| What is a laryngospasm? How is it fixed? | vocal cords snap shut, provide positive pressure |
| When can a nasal canula be used to deliver nitrous? | never - no scrubber |
| What is the highest level of nitrous allowed by the regulator? | 70% |
| What does the O2 flush button do on the regulator? | fills the reservoir bag with 100% O2 to be used in an emergency |
| When do the effects of nitrous begin and when to they peak? | 30sec, 5" |
| How long until nitrous completely eliminated? | 5-10" |
| 20% nitrous with 80% O2 is effective as what amount of MSO4? | 15mg |
| How does nitrous affect pain threshold before injection? | increases |
| What % of general dentists, oms and pediatrics use nitrous? | 56% general, 85% oms, 88% peds |
| How does anxiety affect pain. | decreases pain tolerance |
| How does nitrous affect circulation and memory? | dilates, amnesic |
| What is the partial pressure of nitrous compared to N2 naturally found in the body? Why is this important? | nitrous has a 31 times greater partial pressure so it will rapidly displace N2 in the body causing an increase in volume and pressure in those spaces |
| What are the cardiovascular contraindications for nitrous. How does nitrous affect the heart? | no contraindications. No significant changes to heart or circulation |
| How does nitrous affect people with upper resp tract infections? | defer due to poor exchange, may be painful in patients with sinusitis |
| How does nitrous affect people with lower resp tract infections? | No affect on asthmatics. May make COPD more suseptible to hypoxia |
| When should nitrous be used in patients with cystic fibrosis, Upper resp infection, pneumothorax and severe COPD with O2 dependent ventilation and pneumoencephalography? | contraindicated in all cases |
| What can result with chronic nitrous use? | weakness, ataxia, paresthesia |
| How does nitrous affect B12? | interferes with at high levels (needed for DNA synthesis and RBC production) |
| What are the nitrous contraindications in blood,liver, GI, Reproductive system, Neuro,CA, allergies, and nutrition disorders, endocrine disorders? | GI - bowel obstruction (nitrous expansion can make worse), pregnant (first tri), Bleomycin sulfate ctx |
| What level of nitrous can cause malignant hypothermia? | none |
| How does nitrous affect the ear? | contraindication - recent tympanic graft, increase in pressure |
| How does nitrous affect the eye? | contraindication if recent eye surgery with gas bubble placement |
| Nitrous is safe for what ASA classes | 1-3 |
| Nitrous scavenging system eliminates gas at how many LPM? | 45LPM |
| Should the patient cross their legs when getting nitrous? | no |
| How many L of O2 for adults? kids? | 6-8, 4-5 |
| How full should the reservoir bag be during nitrous? | 2/3 |
| What % should nitrous be started at? How long 100% O2 before start nitrous? | 20%, 5" |
| How much should the nitrous be increased by every minute? | 10% |
| What % of population are hyporesponders to nitrous? | 18% |
| What are the preliminary signs of nitrous oversedation? | increased salivation, nausea, diaphoresis |
| What should be done to recover a patient from an adverse nitrous reaction? | 100% O2 for 5 minutes or until the patient is responding normally |
| What are the parameters for recovery of BP, RR and Pulse? | BP within 10 of normal, Pulse within 10 of normal and RR within 5 of normal |
| Cognitive and motor skill are reported at what level of nitrous? | 50ppm |
| What is the max exposure limit for personal? | 50ppm (not scientific, ADA doesn't like) |
| How does nitrous affect pregnancy? | disrupt folate |
| What % of children require general? | 2-5% |
| What are the indications for general? | traumatic, mentally or physically ill, senile, disoriented, |
| What ASA patients can't use general? | ASA 3 or more |
| What are the 4 stages of conscious sedation? | 1 analgesia, 2 excitement (bad), 3 surgical anesthesia, 4 overdose |
| What is another safe inhaled analgesic? | sevofluorane (ether and chloroform are not safe) |
| How do opioids affect BP? | hypotension |
| Where do opioids act in the brain? | reticular activating system; MU receptors |
| What part of the brain do benzo's act? | limbic system and thalamus |
| What is the difference between pulse oximetry and capnography? | pulse oximetry has a 4-5 minute lag time. CO2 has no lag time (not required yet) |
| What type of stethoscope is used for general? | pre-cordial |
| What is the most dangerous part of surgery? | recovery |
| What is the protocol for reporting adverse reactions to general? | written report to board within 5 days, include all pt records |
| Define general? | no response or memory |
| Why is one anesthetic preferred over another? | safety margin and minimum toxicity |
| What is the lipocentric theory and unitary theory? | gas alters lipid bilary, gas dissolves lipid bilayer |
| What is the proteocentric theory? | gas changes protein structure - prevents conformational changes needed for the membrane |
| What is MAC? What level is needed for anesthesia? | minimum alveolar concentratin.(Prevent movement in 50% of subjects after incision) 0.5 to 2.0 |
| What is MAC-awake? | concentration in which appropriate responses are lost in 50% of patients (coorelates with amnesia and loss of awareness) |
| How does blood gas coefficient affect induction time? | the higher the coefficient the longer the induction time |
| What lead to rapid improvement in gas characteristics? | halogenation |
| What is the problem with halothane? | corrosion |
| What med replaced halothane? | enflurane - low arrthythmia risk, less tachypnea, no hepatic necrosis |
| What is the risk of all gasses? What is the antidote? | malignant hyperthermia, dantrolene |
| How does enflurane affect respiration? | potent depression. need assisted ventilation |
| How much less enflurane is metabolized than halothane? | 5 fold less |
| What is the main problem with enflurane? | seizure - avoid with bad EEG, not widely used in kids |
| What are the advantages to enflurane? | adjust fast, good ralaxer, can use epi more freely |
| How does isoflurane affect the heart? | no arrythmias, does not sensitize the heart to epi |
| How does isoflurane affect the airway? | more respiratory depression, more stimulation of airway reflexes |
| What are the drawbacks to isoflurane? | smells |
| What are the advantages to isoflurane? | depth of anesthesia can be controlled quickly, no problems with arrythmias or head injuries |
| What is the most widely used anesthetic gas? | isofluorane |
| What are the main advantages to sevoflurane? | extremely rapid onset and recovery, not corrosive |
| What is the main drawback to sevoflurane? | malignant hypothermia |
| What class of med is thiopental? | barbiturate |
| How does thiopental affect the CNS? | enhances binding of GABA to GABAa receptors, opens chloride channels and inhibits glutamate receptors |
| What are the cardiovascular effects of thiopental? | minimal unless some hypotension already exists, then thiopental can exaggerate the hypotension |
| Is thiopental metabolized through the kidney or liver? | neither - action terminated due to redistribution in the brain |
| What are the properties of an ideal inducing agent for gas anesthesia? | rapid change to surgical level of anesthesia then leaves just as rapidly to prevent combined effects |
| What does porphyria cause? what med is contraindicated with this problem? | dog/wolf behavior. Thiopental |
| What is neurolept analgesia? what meds are used? | a state of indifference. fentanyl and nitrous, or fentanyl and madazolam |
| What happens if the fentanyl rate is to slow? fast? | slow delerium, fast spasm of chest wass |
| How does fentanyl affect breathing? and seizure patients | large respiratory depression, lowers seizure threshold |
| What effects does ketamine have on the brain? | strong dissociation on the environment. sedation, immobility, amnesia and marked analgesia |
| How does ketamine work in the brain? | inhibits NMDA receptors |
| What drug can cause hallucinations to occur for weeks? | ketamine |
| What pathology contradicts the use of ketamine? | head injury, avoid in CV patinets |
| How does propofol affect blood pressure and respiratory rate? | 30% drop due to peripheral dilation, profound respiratory depression |
| How does propofol affect kidney and renal function? | no effects, no malignant hypothermia risk |
| What are the four classes of mallampati airways? | class 1 hard + soft palate + uvula + faucial pillars visible, class 2 only part of the uvula and faucial visible, class 3 only hard and soft palate visible, class 4 nothing or just the hard palate or tongue visible |
| KNOW What is an ASA 1-4 physical status? | 1 normal, 2 mild systemic, 3 severe systemic, 4 severe systemic threat to life |
| KNOW what are the SOAPMS of sedation foundation? | suction, oxygen, airway equipment, pharm agents, monitors, special equipment |
| KNOW how often should vitals be monitored during sedation? | q 5" |
| KNOW What is required to monitor people with minimal sedation (anxiolysis)? | intermittent assessment and observation |
| KNOW What is required to monitor people with moderate sedation? | Pulse ox, HR, RR, BP recorded intermittently |
| KNOW What is required to monitor people with moderate sedation? | Pulse ox, HR, RR, BP q3", continous ECG and precordial stethoscope |
| KNOW Is a person having general anesthesia able to respond to a cervical stimuli? | no |
| KNOW what level of sedation do I need to be able to rescue the patient from? | from levels deeper than intended |
| KNOW Why are rectal drugs effective? How does the dose need to be adjusted? | Superior hemorrhoidal vein drains into the portal system (first pass effect). 1.5x's |
| KNOW What are common routes of sedation? Which is the least successful? | IV, IM, transmucosal, inhalation, enteral. enteral |
| KNOW What is the minimum time for observation after general sedation? | 1 hour unless a reversal agent administered then 2 hours. patient can't drive self home |
| KNOW What was the type and % of first events in 60 deaths r/t anesthesia? | 80% respiratory |
| KNOW What is poor outcome of anesthesia associated with? | poor monitoring, inadequate initial eval and poor recovery |
| KNOW What are the three most common causes of death in adverse sedation events? | hypoxemia, airway obstruction and cardiovascular collapse (1 tongue, 2 saliva, 3 vomit, 4 foreign object) |
| How old are kids when they develop an adult larynx? | 8 |
| What route are most adverse anesthesia events associated with? | no specific route |
| KNOW what are 2 causes of airway resistance? | obstruction and secretions in the airway |
| KNOW what are two causes of airway obstruction? | tongue and pharyngeal structures |
| KNOW how does PaCO2 change as PaO2 increases? | decreases |
| What is a normal PaO2? | 100mmHg |
| What is alveolar ventilation? | (tidal volume - dead space) x RR |
| What is the difference between stridor respirations and wheezing? | stridor hard to get air in, wheezing hard to get air out |
| KNOW what is agitation during sedation presumed to be unless proven otherwise? | hypoxia |
| Name four reasons that O2 sats decrease | atelectasis, dead space respiration, pneumothorax, loss of respiratory drive |
| How is cardiac output determined? | heart rate x stroke volume |
| KNOW what is bradycardia presumed to be in children unless proven otherwise? | hypoxia |
| KNOW how is blood pressure affected during adverse anesthesia? | normal until decompensation |
| KNOW guidelines for NPO status prior to sedation < 6months and > 6 months | clear liq 2 hours both, solids/nonclear 4-6hours <6months, 6hours >6months |
| What percent of anesthesia adverse events are preventable and a result of human error? | 80 percent - lead to the development of ASA classification |
| how many states allow oral sedation in children | 3 |
| What level of sedation is provided by <50% nitrous? | minimal |
| How often should BP and pulse be evaluated in a patient with minimal sedation? | pre and post op and prn |
| when can staff take over patient monitoring for sedation? | when patient reaches minimal sedation level |
| How often should skin color and pulse ox be evaluated in patients receiving moderate sedation | continuously |
| What special monitoring is needed for patients receiving deep sedation? | EKG, end tidal CO2 (ETCO2), BP, HR, RR continuously |
| When should body temp be measured in deep sedation | should be available, must use whenever a high risk malignant hypothermia agent is used |
| How accurate is peripheral cyanosis in detecting hypoxia? | bad indicator due to lags |
| What is the normal O2 sat? PaO2? | 90%, 60mmHg |
| At what % sat level should action be taken to correct? | 94% |
| How does ETCO2 change in malignant hypothermia? | increases |
| What are 3 early signs of malignant hypothermia? | early masseter contraction, tachycardia, increased ETCO2 |
| What class of drug is high risk for malignant hypothermia? | inhalation anesthetics |
| How do nausea and hypoglycemia affect heart rate? | tachycardia |
Created by:
Absolute