Category Archives: Articles

Surgical Tip of the Week

#28 Sedation Emergencies

Surgical Tip #28

5. EMESIS AND ASPIRATION

Emesis is possible following the administration of sedative drugs including nitrous oxide. Although, aspiration of vomitus is unlikely when airway protective reflexes are intact, dentists should be prepared for this emergency. A thorough patient interview may reveal a history of nausea and vomiting. Sedated patients should be NPO for 6 hours prior to the removal of third molars. Unfortunately, patients are not always compliant with this rule. Slow titration of drugs to light or moderate sedation reduces the possibility of nausea and vomiting.

Surgical Tip of the Week

#27 Sedation Emergencies

Surgical Tip #27

4. BRONCHOSPASM

Bronchospasm is a lower airway obstruction resulting from contraction or spasm of bronchial smooth muscle. Laryngeal edema is a common characteristic. Bronchospasm can result from an anaphylactic reaction or from a hyperactive airway as found with asthmatic patients. Dyspnea and wheezing are common characteristics of bronchospasm due to obstructions in the chest; not the throat or mouth. Stress may trigger an asthmatic attack and bronchospasm.
Surgical Tip #27

Surgical Tip of the Week

#26 Sedation Emergencies

Surgical Tip #26

3. ALLERGIC REACTION

It’s not uncommon for a patient’s medical history to list adverse drug reactions. Histories of compromised airway or difficulty breathing should be taken seriously. These reports indicate severe allergic reaction and anaphylaxis. Allergic reactions can be reduced by completing a thorough medical history and interview. Intravenous administration of a drug test dose and titration may provide an early warning of adverse reactions.
Surgical Tip-#26

Surgical Tip of the Week

#25 Sedation Emergencies

Surgical Tip #25

2. RESPIRATORY DEPRESSION
Surgical Tip #25Respiratory depression must be distinguished from airway obstruction. The risk of respiratory depression is low with moderate sedation when compared to anatomical airway obstruction (tongue, tonsils, adenoids). Patients with airway obstruction can’t breathe. Patients with respiratory depression won’t breathe. Respiratory depression is a side effect of CNS depressants. All opioids and sedatives have the potential to depress hypercapnic or hypoxemic drives. Opioids are the most powerful respiratory depressants.

Surgical Tip of the Week

#24 Sedation Emergencies

Surgical Tip #24

1. AIRWAY OBSTRUCTION
Surgical Tip #24Airway obstruction can be mechanical or pathological. Upper airway obstruction is caused by anatomical structures or foreign materials. The most common upper airway obstruction is the tongue. Common foreign materials include crowns, bridges, and teeth. Lower airway obstruction is caused by bronchospasm, laryngospasm, or allergic reaction. Airway obstruction leads to hypoventilation and hypoxemia. It can be prevented by titration of drugs and the use of a throat pack barrier.

Surgical Tip of the Week

#23 The Sedation Continuum

Surgical Tip 22

The concept of sedation as a continuum is the foundation of patient safety. Sedation is a continuum of levels of sedation from fully consciousness to unconsciousness (general anesthesia).

Surgical Tip 22

General Analgesia

  • A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation.
  • The ability to independently maintain ventilatory function is often impaired.
    • Patients often require assistance in maintaining a patent airway.
    • Positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function.
  • Cardiovascular function may be impaired.

Surgical Tip of the Week

#22 The Sedation Continuum

Surgical Tip 22

The concept of sedation as a continuum is the foundation of patient safety. Sedation is a continuum of levels of sedation from fully consciousness to unconsciousness (general anesthesia).

Surgical Tip 22

Deep Sedation/Analgesia

  • A drug-induced depression of consciousness during which patients cannot be easily aroused, but
    • respond purposefully following repeated or painful stimulation.
    • reflex withdrawal from a painful stimulus is NOT considered a purposeful response
  • The ability to independently maintain ventilatory function may be impaired.
    • Patients may require assistance in maintaining a patent airway.
    • Spontaneous ventilation may be inadequate.
  • Cardiovascular function is usually maintained.

Surgical Tip of the Week

#21 The Sedation Continuum

Surgical Tip 19

The concept of sedation as a continuum is the foundation of patient safety. Sedation is a continuum of levels of sedation from fully consciousness to unconsciousness (general anesthesia).

Surgical Tip 19

Moderate Sedation/ Analgesia (“Conscious Sedation”)

  • A drug-induced depression of consciousness during which
    • patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation
    • reflex withdrawal from a painful stimulus is NOT considered a purposeful response
  • No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.
  • Cardiovascular function is usually maintained.

Surgical Tip of the Week

#20 The Sedation Continuum

Surgical Tip 19

The concept of sedation as a continuum is the foundation of patient safety. Sedation is a continuum of levels of sedation from fully consciousness to unconsciousness (general anesthesia).

Surgical Tip 19

Dentists providing sedation must have the training, skills, drugs and equipment necessary to manage patients that are more deeply sedated than intended until EMS arrives or the patient returns to the intended level of sedation.

Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.

Surgical Tip of the Week

#19 The Sedation Continuum

Surgical Tip 19

The concept of sedation as a continuum is the foundation of patient safety. Sedation is a continuum of levels of sedation from fully consciousness to unconsciousness (general anesthesia).

Surgical Tip 19

Dentists providing sedation must have the training, skills, drugs and equipment necessary to manage patients that are more deeply sedated than intended until EMS arrives or the patient returns to the intended level of sedation.