ABPD OCE REVIEW QUESTIONS
What are the 5 goals of sedation? - Answer -1. to guard the patient's safety and welfare
2. to minimize physical discomfort and
pain
3. to control anxiety, minimize psychological trauma,
and maximize the potential for amnesia
4. to modify behavior and/or movement so as to allow the safe completion of the
procedure
5. to return the patient to a state in which
discharge from medical/dental supervision is safe
What is the criteria for safe discharge of a patient after sedation? - Answer -1.
Cardiovascular function and airway patency are satisfactory and stable.
2. The patient is easily arousable, and protective airway
reflexes are intact.
3. The patient can talk (if age appropriate).
4. The patient can sit up unaided (if age appropriate).
5. For a very young child or a child with disability who is
incapable of the usually expected responses, the pre-sedation level of responsiveness
or a level as close as possible to the normal level for that child should be achieved.
6. The state of hydration is adequate.
Define ASA I, ASA II, ASA III, ASA IV - Answer -ASA = American Society of
Anesthesiologist
Class I: A normally healthy patient with no organic, physiologic, biochemical or
psychiatric disturbance or disease.
Class II: A patient with mild-moderate systemic disturbance or disease (eg, controlled
reactive airway disease).
Class III: A patient with severe systemic disturbance or disease that limits activity but is
not incapacitating (eg, a child who is actively wheezing).
Class IV: A patient with severe and life threatening systemic disease or disorder (eg, a
child with status asthmaticus).
What should be included in informed consent for treatment? - Answer -1. legal name
and date of birth of patient.
2. legal name and relationship to the pediatric patient/
legal basis on which the person is granting permission on behalf of the patient.
3. patient's diagnosis.
4. nature and purpose of the proposed treatment in simple terms.
5. potential benefits and risks associated with that treatment in simple terms.
6. professionally-recognized or evidence-based alternative treatment - including no
treatment - to recommended therapy and risk(s) of each treatment modality in simple
terms.
, 7. place for the parent to indicate that all questions have been asked and adequately
answered.
8. places for signatures of the parent, dentist, and an
office staff member as a witness
What are NPO guidelines for sedation? - Answer -2 hours- clear liquids
4 hours- breastmilk
6 hours- infant formula, nonhuman milk, light meal
8 hours- heavy meal (fried, fatty, meat)
What is included in monitoring of a patient under sedation? - Answer -1. continuous
monitoring of oxygen saturation and heart rate
2. when bidirectional verbal communication between the provider and patient is
appropriate and possible (ie, patient is developmentally able and purposefully
communicates), monitoring of ventilation by
(1) capnography (preferred) or (2) amplified, audible pretracheal stethoscope (eg,
Bluetooth technology) or precordial stethoscope is strongly recommended.
3. If bidirectional verbal communication is not appropriate or not possible, monitoring of
ventilation by capnography (preferred), amplified, audible
pretracheal stethoscope, or precordial stethoscope is required.
4. Heart rate, respiratory rate, blood pressure, oxygen saturation, and expired carbon
dioxide values should be recorded at minimum of every 10 minutes
Diazepam - Answer -AKA Valium
- Benzodiazepine
- MOA: binding to GABA-A receptor
- CNS depression with minimal cardiovascular or respiratory effect
- Amnesia, ataxia
- Onset 45-60 minutes, peak 60 minutes
- Dosage: 0.25-0.30 mg/kg orally
- Half-life is 20-40 hours
- Reversal: Flumazenil 0.01mg/kg (max 0.2 mg); repeated to total of 1mg
- Contraindications: narrow angle glaucoma
Midazolam - Answer -AKA Versed
- Benzodiazepine with sedative-hypnotic properties esp. at higher concentrations
- MOA: reversible binding to GABA-A receptors in CNS, increasing inhibitory effects of
GABA,
- CNS depression with minimal cardiovascular or respiratory effect
- Anterograde amnesia
- Onset 15 minutes, 30-40 minute working time
- Dosage: 0.5-0.75 mg/kg orally, 0.2-0.3 mg/kg nasally
- Reversal: Flumazenil 0.01mg/kg (max 0.2 mg); repeated to total of 1mg
- Side effect: hiccups
- 3-4x potency of diazepam
What are the 5 goals of sedation? - Answer -1. to guard the patient's safety and welfare
2. to minimize physical discomfort and
pain
3. to control anxiety, minimize psychological trauma,
and maximize the potential for amnesia
4. to modify behavior and/or movement so as to allow the safe completion of the
procedure
5. to return the patient to a state in which
discharge from medical/dental supervision is safe
What is the criteria for safe discharge of a patient after sedation? - Answer -1.
Cardiovascular function and airway patency are satisfactory and stable.
2. The patient is easily arousable, and protective airway
reflexes are intact.
3. The patient can talk (if age appropriate).
4. The patient can sit up unaided (if age appropriate).
5. For a very young child or a child with disability who is
incapable of the usually expected responses, the pre-sedation level of responsiveness
or a level as close as possible to the normal level for that child should be achieved.
6. The state of hydration is adequate.
Define ASA I, ASA II, ASA III, ASA IV - Answer -ASA = American Society of
Anesthesiologist
Class I: A normally healthy patient with no organic, physiologic, biochemical or
psychiatric disturbance or disease.
Class II: A patient with mild-moderate systemic disturbance or disease (eg, controlled
reactive airway disease).
Class III: A patient with severe systemic disturbance or disease that limits activity but is
not incapacitating (eg, a child who is actively wheezing).
Class IV: A patient with severe and life threatening systemic disease or disorder (eg, a
child with status asthmaticus).
What should be included in informed consent for treatment? - Answer -1. legal name
and date of birth of patient.
2. legal name and relationship to the pediatric patient/
legal basis on which the person is granting permission on behalf of the patient.
3. patient's diagnosis.
4. nature and purpose of the proposed treatment in simple terms.
5. potential benefits and risks associated with that treatment in simple terms.
6. professionally-recognized or evidence-based alternative treatment - including no
treatment - to recommended therapy and risk(s) of each treatment modality in simple
terms.
, 7. place for the parent to indicate that all questions have been asked and adequately
answered.
8. places for signatures of the parent, dentist, and an
office staff member as a witness
What are NPO guidelines for sedation? - Answer -2 hours- clear liquids
4 hours- breastmilk
6 hours- infant formula, nonhuman milk, light meal
8 hours- heavy meal (fried, fatty, meat)
What is included in monitoring of a patient under sedation? - Answer -1. continuous
monitoring of oxygen saturation and heart rate
2. when bidirectional verbal communication between the provider and patient is
appropriate and possible (ie, patient is developmentally able and purposefully
communicates), monitoring of ventilation by
(1) capnography (preferred) or (2) amplified, audible pretracheal stethoscope (eg,
Bluetooth technology) or precordial stethoscope is strongly recommended.
3. If bidirectional verbal communication is not appropriate or not possible, monitoring of
ventilation by capnography (preferred), amplified, audible
pretracheal stethoscope, or precordial stethoscope is required.
4. Heart rate, respiratory rate, blood pressure, oxygen saturation, and expired carbon
dioxide values should be recorded at minimum of every 10 minutes
Diazepam - Answer -AKA Valium
- Benzodiazepine
- MOA: binding to GABA-A receptor
- CNS depression with minimal cardiovascular or respiratory effect
- Amnesia, ataxia
- Onset 45-60 minutes, peak 60 minutes
- Dosage: 0.25-0.30 mg/kg orally
- Half-life is 20-40 hours
- Reversal: Flumazenil 0.01mg/kg (max 0.2 mg); repeated to total of 1mg
- Contraindications: narrow angle glaucoma
Midazolam - Answer -AKA Versed
- Benzodiazepine with sedative-hypnotic properties esp. at higher concentrations
- MOA: reversible binding to GABA-A receptors in CNS, increasing inhibitory effects of
GABA,
- CNS depression with minimal cardiovascular or respiratory effect
- Anterograde amnesia
- Onset 15 minutes, 30-40 minute working time
- Dosage: 0.5-0.75 mg/kg orally, 0.2-0.3 mg/kg nasally
- Reversal: Flumazenil 0.01mg/kg (max 0.2 mg); repeated to total of 1mg
- Side effect: hiccups
- 3-4x potency of diazepam
