4- oral sedation

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What is the defining characteristic of a monitor as opposed to an instrument?

It measures the central nervous system

It measures physiologic functions

It delivers an audible or visual warning when the measured function falls outside predetermined parameters (correct)

It is noninvasive

Which of the following is NOT a requirement of the ideal monitoring device according to the text?

Highly technical (correct)

Reliable

Stable

Easily integrated with other monitoring equipment

Which physiologic functions are typically measured by monitoring devices according to the text?

Immune system, Digestive system, Skeletal system, Endocrine system

Central nervous system, Respiratory system, Cardiovascular system, Temperature (correct)

Muscular system, Endocrine system, Skeletal system, Digestive system

Urinary system, Lymphatic system, Integumentary system, Reproductive system

What is the recommended heart rate range for adults before starting treatment?

Between 60 and 110 beats per minute Signup and view all the answers

In which type of sedation is continuous pulse monitoring mandatory?

General anesthesia Signup and view all the answers

Which vital signs are recommended to be monitored at regular intervals during parenteral sedation?

Pulse, blood pressure, and oxygen status Signup and view all the answers

What blood pressure level represents an ASA 4 risk according to the text?

a and b Signup and view all the answers

Which method is mentioned as the second method to determine the status of a patient’s cardiovascular system?

Blood pressure monitoring Signup and view all the answers

At what blood pressure level should medical consultation and management be sought before the start of elective dental or surgical care?

200 mm Hg systolic Signup and view all the answers

Why is intra-arterial blood pressure monitoring not really needed during outpatient sedation?

Outpatient sedation typically involves lower risk procedures Signup and view all the answers

Why are standard lead I (right arm → left arm) or lead II (right arm → left leg) most commonly used during anesthesia for electrocardiography?

They permit excellent detection of dysrhythmias Signup and view all the answers

What increases one’s ability to detect possibly significant changes in the functioning of the myocardium at a time when corrective treatment may usually restore a normal rhythm?

electrocardiography Signup and view all the answers

When are dysrhythmias more likely to appear, according to the text?

During general anesthesia Signup and view all the answers

What are two common causes of dysrhythmias according to the text?

Hypoxia and endogenous catecholamine release Signup and view all the answers

Why is casual monitoring by observation of the rise and fall of the patient’s chest considered unreliable?

It may not detect respiratory depression or arrest in time Signup and view all the answers

What is the value of the precordial-pretracheal stethoscope as a monitoring device?

It is valuable for monitoring breathing during general anesthesia and sedation Signup and view all the answers

When is tachypnea most likely to occur according to the text?

In the presence of anxiety or pathologic conditions Signup and view all the answers

What does bradypnea indicate according to the text?

It is noted after administration of larger doses of opioid agonist analgesics Signup and view all the answers

What is the main function of a pulse oximeter as mentioned in the text?

Detecting and quantifying hypoxemia Signup and view all the answers

Which wavelengths of light does the pulse oximeter measure as they pass through living tissue?

660 nm and 910 nm Signup and view all the answers

What percentage of patients who received anesthesia demonstrated hypoxia during routine surgical procedures in one study mentioned in the text?

53% Signup and view all the answers

Which type of hemoglobin absorbs the selected wavelengths of light measured by the pulse oximeter?

Both HbO2 and Hb Signup and view all the answers

What principle do noninvasive CO2 monitors use to measure the levels of inspired and end-tidal CO2?

Infrared absorption Signup and view all the answers

When do audible and visual alarms alert the operator when using CO2 monitors?

When apnea occurs Signup and view all the answers

What is the frequency with which the CO2 monitor assesses the patient's breath?

Every breath taken by the patient Signup and view all the answers

What does the bispectral (BIS) index range from, as mentioned in the text?

0 to 100 Signup and view all the answers

What does the Aspect EEG monitor quantitate?

Hypnotic component of anesthesia Signup and view all the answers

What is the main purpose of Bispectral Electroencephalographic Monitoring (BIS Monitoring) as mentioned in the text?

Quantitating anesthetic effects on the brain Signup and view all the answers

Why is it important to determine whether a patient has an elevated temperature before the start of planned treatment?

To assess the impact on the cardiovascular and respiratory systems Signup and view all the answers

Which route is mentioned as the most practical method for routinely monitoring temperature in a dental office?

Oral route Signup and view all the answers

What is the advantage of using digital thermometers for monitoring body temperature?

They provide a rapid assessment of body temperature Signup and view all the answers

What is one of the purposes of preparing a written record for each patient during the administration of sedative or anesthetic drugs?

To serve as a trend plot of vital values Signup and view all the answers

What is a disadvantage of oral sedation mentioned in the text?

Reliance on patient compliance Signup and view all the answers

What is an advantage of oral sedation according to the text?

Decreased severity of adverse reactions Signup and view all the answers

Which factor influences the absorption of drugs from the GI tract by affecting the gastric emptying time?

Anxiety Signup and view all the answers

In what form are drugs more rapidly absorbed, according to the text?

Aqueous solution Signup and view all the answers

What is estimated to be delayed by as much as two times in a fearful patient, thereby delaying the onset of action of anti-anxiety drugs?

Gastric emptying time Signup and view all the answers

What is the primary use of the oral route mentioned in the text?

Anxiety management Signup and view all the answers

What is a common problem with recommended doses mentioned in the text?

They often lead to inadequate anxiety reduction in the dental setting Signup and view all the answers

What is the primary purpose of titration by appointment?

To assess the efficacy of sedation achieved at the first appointment and adjust drug dosage if necessary Signup and view all the answers

Why is titration by appointment important dentistry?

To ensure that the appropriate drug dosage is achieved through gradual adjustments Signup and view all the answers

Which type of sedative-hypnotics is not a benzodiazepine?

Zolpidem Signup and view all the answers

At what dosage do benzodiazepine sedative-hypnotics produce hypnosis?

Higher dosages Signup and view all the answers

Which sedative-hypnotic is a chloral derivative?

Chloral hydrate Signup and view all the answers

Where are the specific receptors for benzodiazepines isolated?

Within the spinal cord and the brain Signup and view all the answers

At what doses do benzodiazepines depress the limbic system and thalamus, according to the text?

Doses smaller than those depressing the reticular activating system (RAS) and the cerebral cortex Signup and view all the answers

What distinguishes the depressant effects of benzodiazepines from barbiturates?

Benzodiazepines depress the limbic system at smaller doses than those depressing the reticular activating system (RAS) and the cerebral cortex, unlike barbiturates Signup and view all the answers

Which benzodiazepine is most suited for patients requiring minimal to moderate sedation to sleep restfully the evening before their treatment?

Triazolam Signup and view all the answers

What is the primary use of oral triazolam in dentistry in North America?

Promotion of restful sleep before treatment Signup and view all the answers

Why is it important to consider the onset and duration of action when choosing a specific benzodiazepine for a patient?

To meet the needs of both the patient and the dentist Signup and view all the answers

What is a contraindication for the use of Valium (Diazepam)?

Allergy Signup and view all the answers

When is the peak time for Valium (Diazepam)?

1 hour Signup and view all the answers

What is the recommended dose of Valium (Diazepam) 1 hour before treatment?

5-10 mg Signup and view all the answers

What is the oral dose of Versed (Midazolam) mentioned in the text?

5 mg/kg Signup and view all the answers

What is the primary advantage of using Versed (Midazolam) over valium?

More potent Signup and view all the answers

What is the typical peak time for triazolam (Halcion) mentioned in the text?

1 hour Signup and view all the answers

What is the recommended dose range for triazolam (Halcion) as mentioned in the text?

0.125-5 mg Signup and view all the answers

What is the recommended dosage range for Alprazolam (Xanax) according to the text?

0.25-1.0 mg Signup and view all the answers

What is a contraindication for the use of Alprazolam (Xanax) as mentioned in the text?

Acute narrow angle glaucoma Signup and view all the answers

What is the dosage range for Zolpidem (Ambien) as mentioned in the text?

5-10 mg Signup and view all the answers

What is the primary purpose of Flumazenil as mentioned in the text?

To compete with benzodiazepine for receptor site Signup and view all the answers

What is the usual dose of Flumazenil for reversing CNS and respiratory depressant effects?

0.2 mg IV over 15 seconds Signup and view all the answers

What is the total dose of Flumazenil that can be administered to reverse CNS and respiratory depressant effects?

1 mg Signup and view all the answers

What is the peak time for Noctec (chloral hydrate) according to the text?

1/2 hour to 1 hour Signup and view all the answers

What is the duration of action for Noctec (chloral hydrate) as mentioned in the text?

4-8 hours Signup and view all the answers

What is the average dose of Noctec (chloral hydrate) according to the text?

500-2000 mg Signup and view all the answers

What is the duration of action for Benadryl (diphenhydramine) as mentioned in the text?

4-6 hours Signup and view all the answers

What is the concentration of diphenhydramine in the elixir form of Benadryl (diphenhydramine) according to the text?

12.5 mg/5ml/teaspoon Signup and view all the answers

What is the typical peak time for Benadryl (diphenhydramine) according to the text?

1 hour Signup and view all the answers

What effect do opioids produce when administered alone in the absence of pain?

Dysphoria Signup and view all the answers

What is the recommended dose of triazolam (Halcion) for dental procedures of moderate length?

0.125–0.5 mg Signup and view all the answers

Why is it prudent to start with a shorter appointment and less invasive treatment when using a sedative agent for dental procedures?

To gauge the appropriateness of the chosen sedative agent Signup and view all the answers

For longer dental appointments (2–4 hours), which benzodiazepine is recommended based on its longer acting nature?

Lorazepam (Ativan) Signup and view all the answers

What has been shown to be effective for short dental procedures (1 hour) based on the text?

Zaleplon 10–20 mg given 1 hour prior Signup and view all the answers

What is the recommended time for evaluating the efficacy of the sedation after administering the sedative drug?

45 minutes Signup and view all the answers

4- oral sedation

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Questions and Answers

What is the defining characteristic of a monitor as opposed to an instrument?

Which of the following is NOT a requirement of the ideal monitoring device according to the text?

Which physiologic functions are typically measured by monitoring devices according to the text?

What is the recommended heart rate range for adults before starting treatment?

In which type of sedation is continuous pulse monitoring mandatory?

Which vital signs are recommended to be monitored at regular intervals during parenteral sedation?

What blood pressure level represents an ASA 4 risk according to the text?

Which method is mentioned as the second method to determine the status of a patient’s cardiovascular system?

At what blood pressure level should medical consultation and management be sought before the start of elective dental or surgical care?

Why is intra-arterial blood pressure monitoring not really needed during outpatient sedation?

Why are standard lead I (right arm → left arm) or lead II (right arm → left leg) most commonly used during anesthesia for electrocardiography?

What increases one’s ability to detect possibly significant changes in the functioning of the myocardium at a time when corrective treatment may usually restore a normal rhythm?

When are dysrhythmias more likely to appear, according to the text?

What are two common causes of dysrhythmias according to the text?

Why is casual monitoring by observation of the rise and fall of the patient’s chest considered unreliable?

What is the value of the precordial-pretracheal stethoscope as a monitoring device?

When is tachypnea most likely to occur according to the text?

What does bradypnea indicate according to the text?

What is the main function of a pulse oximeter as mentioned in the text?

Which wavelengths of light does the pulse oximeter measure as they pass through living tissue?

What percentage of patients who received anesthesia demonstrated hypoxia during routine surgical procedures in one study mentioned in the text?

Which type of hemoglobin absorbs the selected wavelengths of light measured by the pulse oximeter?

What principle do noninvasive CO2 monitors use to measure the levels of inspired and end-tidal CO2?

When do audible and visual alarms alert the operator when using CO2 monitors?

What is the frequency with which the CO2 monitor assesses the patient's breath?

What does the bispectral (BIS) index range from, as mentioned in the text?

What does the Aspect EEG monitor quantitate?

What is the main purpose of Bispectral Electroencephalographic Monitoring (BIS Monitoring) as mentioned in the text?

Why is it important to determine whether a patient has an elevated temperature before the start of planned treatment?

Which route is mentioned as the most practical method for routinely monitoring temperature in a dental office?

What is the advantage of using digital thermometers for monitoring body temperature?

What is one of the purposes of preparing a written record for each patient during the administration of sedative or anesthetic drugs?

What is a disadvantage of oral sedation mentioned in the text?

What is an advantage of oral sedation according to the text?

Which factor influences the absorption of drugs from the GI tract by affecting the gastric emptying time?

In what form are drugs more rapidly absorbed, according to the text?

What is estimated to be delayed by as much as two times in a fearful patient, thereby delaying the onset of action of anti-anxiety drugs?

What is the primary use of the oral route mentioned in the text?

What is a common problem with recommended doses mentioned in the text?

What is the primary purpose of titration by appointment?

Why is titration by appointment important dentistry?

Which type of sedative-hypnotics is not a benzodiazepine?

At what dosage do benzodiazepine sedative-hypnotics produce hypnosis?

Which sedative-hypnotic is a chloral derivative?

Where are the specific receptors for benzodiazepines isolated?

At what doses do benzodiazepines depress the limbic system and thalamus, according to the text?

What distinguishes the depressant effects of benzodiazepines from barbiturates?

Which benzodiazepine is most suited for patients requiring minimal to moderate sedation to sleep restfully the evening before their treatment?

What is the primary use of oral triazolam in dentistry in North America?

Why is it important to consider the onset and duration of action when choosing a specific benzodiazepine for a patient?

What is a contraindication for the use of Valium (Diazepam)?

When is the peak time for Valium (Diazepam)?

What is the recommended dose of Valium (Diazepam) 1 hour before treatment?

What is the oral dose of Versed (Midazolam) mentioned in the text?

What is the primary advantage of using Versed (Midazolam) over valium?

What is the typical peak time for triazolam (Halcion) mentioned in the text?

What is the recommended dose range for triazolam (Halcion) as mentioned in the text?

What is the recommended dosage range for Alprazolam (Xanax) according to the text?

What is a contraindication for the use of Alprazolam (Xanax) as mentioned in the text?

What is the dosage range for Zolpidem (Ambien) as mentioned in the text?

What is the primary purpose of Flumazenil as mentioned in the text?

What is the usual dose of Flumazenil for reversing CNS and respiratory depressant effects?

What is the total dose of Flumazenil that can be administered to reverse CNS and respiratory depressant effects?

What is the peak time for Noctec (chloral hydrate) according to the text?

What is the duration of action for Noctec (chloral hydrate) as mentioned in the text?

What is the average dose of Noctec (chloral hydrate) according to the text?

What is the duration of action for Benadryl (diphenhydramine) as mentioned in the text?

What is the concentration of diphenhydramine in the elixir form of Benadryl (diphenhydramine) according to the text?

What is the typical peak time for Benadryl (diphenhydramine) according to the text?

What effect do opioids produce when administered alone in the absence of pain?

What is the recommended dose of triazolam (Halcion) for dental procedures of moderate length?

Why is it prudent to start with a shorter appointment and less invasive treatment when using a sedative agent for dental procedures?

For longer dental appointments (2–4 hours), which benzodiazepine is recommended based on its longer acting nature?

What has been shown to be effective for short dental procedures (1 hour) based on the text?

What is the recommended time for evaluating the efficacy of the sedation after administering the sedative drug?

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