Sedation Course Flashcards
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Questions and Answers

Use of propofol or ketamine would automatically categorize a sedation procedure as deep sedation, based on the medication used.

False

Patients receiving prilocaine, articaine, benzocaine, nitrates, or sulfa antibiotics may be at risk for:

  • SARS-Co-V2 infection
  • Cholecystitis
  • Methemoglobinemia (correct)
  • Local anesthetic toxicity

    • On the capnographic wave form, an upward slope of the plateau commonly indicates:

  • Hypoventilation
  • Methemoglobinemia
  • Hyperventilation
  • Airway obstruction (correct)

    • A metabolic equivalent score (METS) greater than _____ indicates good cardiac reserve and low cardiac risk, according to the Duke Activity Status Index.

    <p>4</p> Signup and view all the answers

    Which of the following should NOT be considered in management of bronchospasm?

    <p>Succinylcholine</p> Signup and view all the answers

    What volume of D50 would you administer if you intend to provide 25 grams of dextrose to the patient?

    <p>50 ml</p> Signup and view all the answers

    As discussed in MAJ Jenzer's lecture, a normal patient with an oxygen saturation of 90% would be expected to have a partial pressure of oxygen of approximately ______ mm Hg.

    <p>60</p> Signup and view all the answers

    Which of the following would NOT be considered appropriate in the management of laryngospasm?

    <p>Epinephrine, 1 mg</p> Signup and view all the answers

    What is the initial dose of flumazenil?

    <p>0.2 mg IV, over a period of 15 seconds</p> Signup and view all the answers

    After the first dose of flumazenil, what should the additional doses be (if needed)?

    <p>0.2 mg IV, repeated at 60 second intervals. Max dose 1.0 mg.</p> Signup and view all the answers

    What is the concentration of naloxone (supplied in the bottle)?

    <p>0.4 mg/ml</p> Signup and view all the answers

    Which of the following could be used to manage intraoperative hypertension? (Select all that apply)

    <p>Allow a restroom break if possible</p> Signup and view all the answers

    What is the onset of fentanyl?

    <p>2 to 3 minutes</p> Signup and view all the answers

    What is the duration of fentanyl?

    <p>30 to 60 minutes</p> Signup and view all the answers

    What is the initial dose of naloxone?

    <p>0.1 to 0.2 mg</p> Signup and view all the answers

    Army dental specialists follow Guidelines for Teaching Pain Control and Sedation to Dentists and Dental students and Guidelines for the Use of Sedation and General Anesthesia by Dentists produced by which of the following entities?

    <p>American Dental Association</p> Signup and view all the answers

    What would be the ASA physical status classification of a patient presenting with a systemic illness that causes some functional limitations?

    <p>3</p> Signup and view all the answers

    Which of the following is NOT characteristic of a benzodiazepine?

    <p>May cause seizures</p> Signup and view all the answers

    Which of the following statements is true?

    <p>Drug R is more efficacious than drug T</p> Signup and view all the answers

    An opioid that is lipophilic will:

    <p>Exhibit rapid onset</p> Signup and view all the answers

    Which of the following is NOT true regarding benzodiazepine mechanism of action?

    <p>Blocks chloride ion influx</p> Signup and view all the answers

    The duration of action for diazepam is:

    <p>1 to 2 hours</p> Signup and view all the answers

    Which of the following is NOT included in the definition of minimal sedation?

    <p>Responds purposefully to verbal commands or light tactile stimulation</p> Signup and view all the answers

    If a patient responds only to repeated or painful stimulation, which level of sedation has been achieved?

    <p>Deep sedation</p> Signup and view all the answers

    According to Southerland et al. (2016), a patient with BP >180/110 with no history of hypertension-related end organ damage and no current symptoms should:

    <p>Be referred to a physician as soon as possible</p> Signup and view all the answers

    Which of the following is NOT a medication that should be avoided or closely managed in patients with compromised renal function?

    <p>Acetaminophen</p> Signup and view all the answers

    Which of the following hormones is produced by the anterior pituitary?

    <p>Adrenocorticotropic hormone</p> Signup and view all the answers

    Which of the following is produced by the hypothalamus?

    <p>Corticotropin-releasing hormone</p> Signup and view all the answers

    Which of the following is produced by the adrenal medulla?

    <p>Epinephrine</p> Signup and view all the answers

    Match the BP with the appropriate classification.

    <p>130 - 139 OR 80 - 89 = ELEVATED Less than 120 AND Less than 80 = NORMAL 120 - 129 AND Less than 80 = ELEVATED Higher than 180 AND/OR Higher than 120 = HYPERTENSIVE CRISIS 140 and above OR 90 and above = HYPERTENSION, Stage 2</p> Signup and view all the answers

    Tachypnea is defined as > _____ breaths per minute at rest.

    <p>20</p> Signup and view all the answers

    According to current policy it is acceptable to achieve minimal sedation using a single oral medication either in one dose or divided doses.

    <p>True</p> Signup and view all the answers

    A patient with an Apnea Hypoxia Index of 5 to 14 during a sleep test would have ________ Obstructive Sleep Apnea.

    <p>Mild</p> Signup and view all the answers

    Which of the following is NOT a negative effect of smoking with regard to sedation?

    <p>Decreased heart rate</p> Signup and view all the answers

    According to the AHA/ACC, a patient with systolic BP 120-129 and diastolic BP < 80 would be in which Blood Pressure Category?

    <p>Elevated</p> Signup and view all the answers

    Heart rate > _____ bpm would be considered tachycardia.

    <p>100</p> Signup and view all the answers

    Which measure is commonly used at Tingay Dental Clinic to prevent diffusion hypoxia?

    <p>100% oxygen for 5 minutes following the sedation</p> Signup and view all the answers

    Nitrous oxide gas is odorless.

    <p>False</p> Signup and view all the answers

    For inhalational anesthetics, Minimum Alveolar Concentration (MAC) is inversely proportional to potency.

    <p>True</p> Signup and view all the answers

    Nitrous oxide exhibits very high solubility in blood.

    <p>False</p> Signup and view all the answers

    An escort is required for nitrous oxide sedation.

    <p>False</p> Signup and view all the answers

    Nitrous oxide may induce a gag reflex.

    <p>False</p> Signup and view all the answers

    Nausea and vomiting are relatively common complications of nitrous oxide sedation.

    <p>True</p> Signup and view all the answers

    Nitrous oxide gas has a pale yellow color.

    <p>False</p> Signup and view all the answers

    What is the maximum percentage of nitrous oxide that can be delivered at Tingay Dental Clinic if the provider is not credentialed for moderate sedation?

    <p>50%</p> Signup and view all the answers

    The oxygen-hemoglobin dissociation curve relates the percentage of saturated hemoglobin to the:

    <p>Partial pressure of oxygen in the blood (mmHg)</p> Signup and view all the answers

    A medication administered rectally would be considered to have been delivered ____________.

    <p>Enterally</p> Signup and view all the answers

    Select ALL of the beta-1 selective beta blockers from the list below.

    <p>Metoprolol</p> Signup and view all the answers

    For ENTERAL SEDATION, positive pressure oxygen must be:

    <p>Immediately available</p> Signup and view all the answers

    Benzodiazepines:

    <p>Are CNS depressants</p> Signup and view all the answers

    Which drug produces a 'hangover effect'?

    <p>Diazepam</p> Signup and view all the answers

    What is the MRD of lorazepam?

    <p>4 mg</p> Signup and view all the answers

    What is the reversal agent for benzodiazepines?

    <p>Flumazenil</p> Signup and view all the answers

    At Tingay Dental Clinic, which reversal agent is ready to administer (without diluting)?

    <p>Flumazenil</p> Signup and view all the answers

    After oral administration, many drugs are absorbed by the small intestine and transported via the ___________ system to the liver, where they undergo extensive metabolism before reaching systemic circulation.

    <p>Portal</p> Signup and view all the answers

    Diazepam is pregnancy category:

    <p>D</p> Signup and view all the answers

    A patient who combines an opioid with a MAOI may develop:

    <p>Serotonin syndrome</p> Signup and view all the answers

    In addition to IV D50, what would be another alternative for managing an unconscious patient with hypoglycemia?

    <p>Glucagon</p> Signup and view all the answers

    One reason for variable efficacy of oral sedative agents is that bioavailability may range from:

    <p>5% to 100%</p> Signup and view all the answers

    Which of the following would be MOST likely to cause respiratory depression when used as a single agent?

    <p>Fentanyl</p> Signup and view all the answers

    In the MHS, it is acceptable to give one tablet of diazepam and one tablet of lorazepam while performing minimal sedation.

    <p>False</p> Signup and view all the answers

    The STOP BANG questionnaire is used to screen for:

    <p>OSA</p> Signup and view all the answers

    Which has the shortest duration of action?

    <p>Triazolam</p> Signup and view all the answers

    What is the MRD of triazolam?

    <p>0.5 mg</p> Signup and view all the answers

    Absolute contraindications to benzodiazepines include: > Narrow angle glaucoma > Hypersensitivity/Allergy AND...

    <p>Untreated wide angle glaucoma</p> Signup and view all the answers

    A patient must be NPO for 8 hours prior to enteral sedation.

    <p>False</p> Signup and view all the answers

    What is the CONCENTRATION of flumazenil (in the bottle)?

    <p>0.1 mg/ml</p> Signup and view all the answers

    Which drug class is associated with a 'paradoxical reaction'?

    <p>Benzodiazepines</p> Signup and view all the answers

    Which organization sets the policy for sedation in Army Dental Treatment Facilities?

    <p>Defense Health Agency</p> Signup and view all the answers

    According to current policy, combination nitrous oxide plus enteral sedation:

    <p>Can be used, but the provider must follow the policy for moderate sedation</p> Signup and view all the answers

    Which TWO of the following forms are REQUIRED (rather than recommended) for ENTERAL sedation at TDC?

    <p>DHA Form 195 - Informed Consent for Sedation and Anesthesia</p> Signup and view all the answers

    What is the FDA pregnancy category of triazolam?

    <p>X</p> Signup and view all the answers

    What is the mechanism of action for benzodiazepines?

    <p>GABA receptor agonist</p> Signup and view all the answers

    Current DHA policy mandates that dental specialists providing moderate sedation must have an observer in the room during the procedure dedicated solely to patient monitoring. This observer may not assist the provider with the clinical procedure being performed.

    <p>False</p> Signup and view all the answers

    According to the current DHA Procedural Instruction, dental assistants present during procedures completed under moderate sedation must complete ACLS certification.

    <p>False</p> Signup and view all the answers

    When monitoring end-tidal CO2 in a closed system (e.g. endotracheal tube in place),

    <p>A nearly ideal 'square' waveform should be expected on the monitor</p> Signup and view all the answers

    When performing end-tidal CO2 monitoring in an open system (e.g. moderate sedation at Tingay Dental Clinic),

    <p>A nearly ideal (square) waveform should not be anticipated</p> Signup and view all the answers

    Which of the following would be an appropriate treatment for bronchospasm?

    <p>Administer albuterol</p> Signup and view all the answers

    The capnographic waveform shown is an example of:

    <p>Hypoventilation</p> Signup and view all the answers

    The capnographic waveform shown is an example of:

    <p>Physiologic variability</p> Signup and view all the answers

    Which of the following is not consistent with the definition of moderate sedation?

    <p>Normal response to verbal stimulation</p> Signup and view all the answers

    How many hours prior to moderate sedation does a patient need to be NPO after eating a 'light meal'?

    <p>6</p> Signup and view all the answers

    Which of the following is not part of an airway evaluation?

    <p>Thickness of keratinized mucosa</p> Signup and view all the answers

    Which of the following is NOT a side effect of morphine?

    <p>Urinary incontinence</p> Signup and view all the answers

    Which of the following is a SYNTHETIC opioid that can cause fatal reactions in patients taking MAO inhibitors?

    <p>Meperidine</p> Signup and view all the answers

    The naloxone in Tingay Dental Clinic is supplied in 1-ml vials. If you dilute this 1-ml in normal saline to a total volume of 4 ml, what concentration is achieved?

    <p>0.1 mg/ml</p> Signup and view all the answers

    Fentanyl is _______ times more potent than morphine.

    <p>100</p> Signup and view all the answers

    On a normal capnogram, the end-tidal CO2 peaks at _________ mmHg.

    <p>35 - 45</p> Signup and view all the answers

    On a capnographic waveform, the vertical line on the right side of each wave is referred to as the:

    <p>Inspiratory downstroke</p> Signup and view all the answers

    Match the electrocardiogram component to the correct aspect of the cardiac cycle.

    <p>Time between beginning of atrial depolarization to beginning of ventricular depolarization = PR interval Atrial depolarization = P wave End of QRS complex = J point Ventricular depolarization = QRS complex Ventricular repolarization = T wave Beginning of ventricular depolarization to end of ventricular repolarization = QT interval</p> Signup and view all the answers

    Please identify this rhythm.

    <p>Third-degree heart block</p> Signup and view all the answers

    In which of Guedel's stages of anesthesia would your patient be if you detect abnormal respiration, eyes divergent, dilated pupils, impaired blink reflex, and/or disinhibited movement?

    <p>Stage II</p> Signup and view all the answers

    Which of the following is NOT included in the definition of DEEP sedation?

    <p>Cardiovascular function may be impaired</p> Signup and view all the answers

    Study Notes

    Sedation Guidelines and Regulations

    • Army dental specialists adhere to guidelines from the American Dental Association for teaching pain control and sedation.
    • The ASA physical status classification categorizes a patient with a systemic illness causing some functional limitations as Class 3.

    Sedation and Medications

    • Benzodiazepines do not produce analgesia and have minimal respiratory depression unless combined with other substances.
    • Diazepam has a duration of action of 1 to 2 hours.
    • Deep sedation is characterized by a patient responding only to repeated or painful stimulation.
    • Nitrous oxide is the only medication allowed at 50% maximum concentration at Tingay Dental Clinic without moderate sedation credentialing.

    Hormones and Drug Mechanisms

    • The anterior pituitary produces Adrenocorticotropic hormone, while the hypothalamus produces Corticotropin-releasing hormone.
    • Benzodiazepines act as GABA receptor agonists, enhancing GABA binding without blocking chloride ion influx.

    Blood Pressure and Heart Rate

    • Blood pressure of 130-139 / 80-89 categorizes as elevated, while > 180 / 110 is a hypertensive crisis.
    • A heart rate exceeding 100 bpm is classified as tachycardia.

    Patient Management and Assessments

    • Patients should be NPO for 6 hours prior to moderate sedation after a light meal.
    • The STOP BANG questionnaire screens for Obstructive Sleep Apnea (OSA).

    Monitoring and Safety

    • End-tidal CO2 monitoring during sedation identifies hypoventilation and airway obstruction, with a normal capnogram showing CO2 peaks at 35-45 mmHg.
    • An escort is not required for nitrous oxide sedation, despite some sedation guidelines.

    Drug-Specific Information

    • Flumazenil reverses benzodiazepine effects and is available at a concentration of 0.1 mg/ml.
    • Fentanyl is 100 times more potent than morphine and is associated with respiratory depression as a single agent.

    Questions Highlight

    • Combination nitrous oxide with enteral sedation is acceptable with adherence to moderate sedation policies.
    • Triazolam has the shortest duration of action among benzodiazepines.
    • The maximum recommended dose (MRD) for lorazepam is 4 mg, while for triazolam, it's 0.5 mg.

    Complications and Contraindications

    • Methemoglobinemia can occur with certain anesthetics and conditions should be assessed before procedures.
    • Absolute contraindications for benzodiazepines include untreated wide-angle glaucoma and hypersensitivity/allergy.

    Clinical Situations and Responses

    • The capnographic waveform can indicate various respiratory conditions; an upward slope suggests airway obstruction.
    • In cases of bronchospasm, albuterol is the preferred treatment option.

    Dosage Calculations and Treatments

    • Administer 50 ml of D50 to provide 25 grams of dextrose to an unconscious patient with hypoglycemia.

    Flumazenil Dosage

    • Initial dose of flumazenil: 0.2 mg IV, administered over 15 seconds.
    • Additional doses, if needed, should be 0.2 mg IV, repeated at 60-second intervals.
    • Maximum cumulative dose for flumazenil: 1.0 mg.

    Naloxone Concentration

    • Naloxone is supplied at a concentration of 0.4 mg/ml.

    Managing Intraoperative Hypertension

    • Effective treatments for managing intraoperative hypertension include:
      • Labetalol: 5-20 mg IV.
      • Esmolol: 10-30 mg IV.
      • Addressing patient discomfort.
      • Allowing restroom breaks when possible.

    Fentanyl Onset and Duration

    • Onset of fentanyl: 2 to 3 minutes.
    • Duration of action: 30 to 60 minutes.

    Initial Dose of Naloxone

    • Initial dose of naloxone ranges from 0.1 to 0.2 mg.

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    Test your knowledge of sedation practices in dentistry with this flashcard quiz. Each card addresses essential guidelines and institutions relevant to pain control and sedation. Ideal for dental students and professionals seeking to enhance their understanding of sedation protocols.

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