Question

Conscious Sedation Case Study A 17-yr-old male is scheduled to get his wisdom teeth removed under conscious sedation.  The nurse explains to the patient and family which medication the physician will likely order during the procedure and what the patient should expect during and after the procedure.

Which medication should the nurse expect the physician to order for conscious sedation and why?

During the procedure, the nurse monitoring the patient obtains the following vitals: P- 64 regular, R- 8 shallow, BP- 110/68, O2 Sat- 93%. The physician performing the procedure is made aware of the vitals.   What orders should the nurse anticipate and why?

The patient is stabilized, the procedure has been successfully completed, and patient is awake and ready to be sent home. What teaching should the nurse provide to the patient and family related to the medication administered during the procedure?

Answer 1

Medication used for Conscious sedation and the reason

Almost all the dentists administer local lidocaine but for conscious sedation dentists may also use nitrous oxide. This is to numb the local area and general anaesthesia during the procedure is rarely used. Conscious sedation is generally used for removing multiple teeth. This type of sedation is used to reduce the anxiety of the person and especially nitrous oxide , laughing gas which can be mixed with oxygen and can easily maintain the levels of sedation by adjusting the levels and can bring back the person to the normal condition.

Nitrous oxide and monitoring the vital signs :

In the given scenario the vital signs given are PR 64, R 8 shallow, BP 110/68, O2 93%.. Actually speaking nitrous oxide is contraindicated in persons with chronic respiratory concerns, emphysema bronchitis etc. and is administered with advanced care and monitoring. Also it leads to heart attack at times during the surgery. These pattern of vital signs shows clearly that there was a respiratory depression for the patient.Because of hypoxemia nitrous oxide produces respiratory depression and some times also causes brain death. As this may lead to death immediately administer the antagonists, immediate opening of airway through ventilation as this creates asphyxia and also patient must be administered Vitamin B12 or Folic acid.

Nitrous oxide administered and the teaching to be provided to family and patient :

Patient and family should be well explained about the drug clearly especially both the long term and short term complications.

Explain about the need of escorting the patient

Assess all the vital signs before sending the patient

Ask the family to call 911 in case of asphyxia and also low blood pressure and increased heart rate.

Administer vitamin B12 and Folic acid to avoid further complications.