Sedation 04

66. What do we use to monitor oxygen saturation and pulse?

ECG

Capnograph device

Pulse oximeter

Blood pressure monitoring device

67. What is the normal oxygen saturation at sea level?

80%

85%

90%

95%

68. When do we stop monitoring the sedated patients?

When the patients start talking normally

When vital signs are be stable as to compared to baseline pre-procedure readings

When oxygen saturation is over 100%

When the patients breath normally

69. What oxygen saturation levels that may cause severe hypoxia?

Between 96% - 100%

Between 86% - 90%

Less than 81%

Less than 71%

70. What level of oxygen saturation when the patient becomes cyanosis?

SpO2 <80%

SpO2 <85%

SpO2 <90%

SpO2 <94%

71. Which one of the following statement is NOT the criteria for discharge of sedated patients?

The patients are able to understand and follow directions

The patients are appropriately talk

The patients are able to drink water

The patients can understand discharge instructions

72. 58. What is not necessary to record in the IV sedation sheet?

Sedative dose

Pulse

Oxygen saturation level

Temperature

73. What is the incorrect instruction after dental treatment under conscious sedation?

Patients may go home within 20 minutes or less without further monitoring

Patients must be monitored until the discharge criteria are met; discharged with a responsible adult; and must be given written clear instructions

Patients may drive home

Patients are not allowed to take codeine as an analgesic

74. Which one of the following statement is NOT the reason for failure of sedation?

Cooperative patient

Wrong site (unable to find vein, unable to titrate)

Unpredicted drug response

Equipment failure (monitoring failure)

75. What is is the most common side-effect of the administration of benzodiazepine drugs?

Sleepiness

Dry mouth

Confusion

Reduction in normal peripheral oxygen sedation (SpO2 < 95%)

76. How much oxygen saturation the pulse oximeter alarm should be programmed to sound?

Less than 80%

Less than 85%

Less than 90%

Less than 95%

77. Which one of the following statement is NOT the management of oxygen desaturation?

Ask the patient to take a few deep breaths

Pinch the earlobe

Give oxygen by facemask at 6-8L/min

Inject hydrocortisone

78. What is the most common sedation risk?

Paradoxical reaction

Anaphylactic reaction

Respiratory depression

Confusion

79. What type of patients are at risk for sedation?

Obesity

Hypertensive patients

Elderly patients

Obesity and Elderly patients

80. How much low flow oxygen by nasal prongs for non-acute respiratory depression?

1 - 2 L/min

2 - 4 L/min

4 - 6 L/min

8 - 10 L/min

81. How much oxygen flow used in anaphylaxis?

2 - 4 L/min

4 - 6 L/min

5 - 7 L/min

8-10 + litres/minute

82. In CPR, how many chest compressions per minute and how many breaths?

15 compressions per minute, one breath

20 compressions per minute, 3 breaths

30 compressions, 2 breaths

40 compressions, 4 breaths

83. What is the half-life of Flumaenil?

30 minutes

<1 hour

˃1 hour

2 hours

84. What is the maximum dose of Flumaenil?

2 ml

4 ml

6 ml

10 ml

85. When do need to put the patients on their side in the recovery position?

When they are breathing but unconscious

When they are not breathing and unconscious

When their pulse and blood pressure are dropped

When they have normal breathing and conscious

86. When should you consider the use of bag mask ventilation or oropharyngeal airways?

When there's a gag reflex

When the patient has got airway obstruction

When there's a respiratory depression

When the patient is unconscious

87. Which one of the following is NOT the abnormal sounds in airway obstruction?

Snoring

Hiccup

Gurgling

Wheezing

88. When a patient has got snoring, what happens to him/her?

He/she is sleepy

His/her throat is obstructed by a foreign body

He/she has got laryngospasm

He/she has got hypopharyngeal obstruction by the tongue

89. How to manage a patient with snoring?

Repeat head-tilt, chin lift

Use bronchodilator medication

Clear airway with a suction tip

Wake the patient up with Flumazenil injection

90. When a patient has got wheezing, what happens to him/her?

He/she has got asthmatic attack

His/her throat is obstructed by a foreign body

He/she has got bronchospasm

He/she has got hypopharyngeal obstruction by the tongue

91. How to manage a patient with wheezing?

Inject 1:1000 adrenalin

Use bronchodilator medication

Clear airway with a suction tip

Repeat head-tilt, chin lift

92. What may happen when a patient is over-sedated?

Reduction in normal peripheral oxygen sedation (SpO2 < 95%) and respiratory depression is usually mild and transient

Increased heart rate

Raised blood pressure (hypertension)

Nausea and vomiting

93. How do you manage the patient when oxygen saturation drops below 90%?

Ask the patient to take a few deep breaths, pinching the earlobe

If the SpO2 is still low give the Oxygen by facemask at 6-8L/min

Give IV reversal drug, Flumazenil if not better

All of the above

94. Who are the patients at risk with sedation?

Chronic respiratory diseases

History of sleep apnea syndrome

Extreme age and obesity

All of the above

95. What type of patient that has got restricted airway?

Obese patients

Down's Syndrome

Heavy smokers

Obese patients and Heavy smokers

96. 82. How do you manage paradoxical reactions?

Inject adrenalin

Inject Flumazenil

Use Naloxone

Use hydrocortine

97. Which one of the following is NOT the predisposing factors for paradoxical reactions?

Young and advanced age

Alcoholism and drug abuse

Patients who are allergic to local anesthetic

Psychiatric disorders

98. How to manage haematoma formation at the IV injection site?

Remove the IV cuff to decrease the venous blood pressure

Remove the needle and apply firm pressure for 5 minutes

If the site is painful apply ice in the first few hours

All of the above

99. Which one of the following is NOT the management of air embolism during IV sedation?

Withdraw air from the vein by using large needle and syringe

Remove air bubbles from the IV tubing before connecting the IV

Remove air bubbles from the syringe before injecting

Periodically check the infusion bag to prevent it employing

100. How much small bubbles of air in the vein can a patient tolerate after IV sedation?

0.2ml of air / kg weight

0.5ml of air / kg weight

Up to 1ml of air /kg weight

Over 2ml of air / kg weight

101. Which one of the following is NOT the symptoms of accidental intra-arterial injection?

A bright-red flash of blood in the cannula

A dark red blood clots under the skin

Pulsatile movement of blood in the IV line

Intense pain or burning at the site of injection

102. How to prevent intra-arterial cannulation during IV sedation?

Always palpate a vessel before applying the IV cuff

Check the colour of blood in the cannula and look for a pulse of blood in the IV tubing

Ask the patient if there is pain or coldness going down the arm when you first inject a saline test

All of the above

103. How to prevent extravascular drug administration during IV sedation?

Always test the IV by injecting first some saline or water for injection

Inject a few drops of Diazepam into the vein first

If a saline drip is being used, hold the IV bag below the patients' heart

Always test the IV by injecting first some saline or water for injection and . If a saline drip is being used, hold the IV bag below the patients' heart

104. Which one of the following is NOT the required equipment for IV sedation?

Pulse Oximeter

Thermometer

Blood pressure monitor

Bag-valve-mask and oxygen cylinder

105. What are the required drugs for IV sedation?

Midazolam and Flumazenil

Adrenalin 1:1000

Other essential emergency drugs

All of the above

106. Which one of the following is NOT the prerequisites for sedation?

Blood tests

Knowledge of the agents to be used

Consent

Adequate equipment & materials

107. What are the guiding principles for sedation of children?

Supervision by medical personnel

Cooperative children

Trained & skilled in both airway management and cardiopulmonary resuscitation

Supervision by medical personnel and Trained & skilled in both airway management and cardiopulmonary resuscitation

108. What advanced knowledge for primary practitioner in conscious sedation?

Capable of providing bag mask ventilation and, ultimately, endotracheal intubation

Understand pharmacology of sedating medications

Maintain advanced pediatric airway skills

All of the above

109. Which one of the following is NOT the basic knowledge for supported personnel?

Be trained in, and capable of providing basic life support

Know how to do tracheotomy

Assist in any supportive or resuscitation measures

Know how to use resuscitation equipment & supplies in the event of an emergency

110. What happens when insulin is injected to a hypoglycaemic patient?

The patient will recover from hypoglycaemia

Blood glucose level will rise up

The patient might die

The patient's blood pressure will go down

111. What does S O A P M E stand for?

Supply, Order, Accident, Pain, Management, Emergency

Suction, Oxygen, Airway, Pharmacy, Monitors, Equipment

Safe, Old, Analgesics, Prescription, Malignancy, Effectiveness

Sedationists of Oral Association for Pediatric Malformation and Epilepsy

112. What is Naxolone used for?

For reversing Benzodiazepines

For pain control

For reversing opioids, eg. Morphine

For anti-inflammatory

113. You have been asked to administer conscious sedation to a healthy, 25 year old female patient in the dental school clinic. She has dental phobia and requires a simple dental extraction. The most appropriate statements in this context include:?

The patient must be able to understand and respond purposefully to verbal commands, throughout the period of sedation

The end point is maintenance of a purposeful response after repeated or painful stimulation

Sedation with IV Midazolam is unlikely to be associated with over-sedation if titrated slowly

Sedative drugs are administered as a single bolus

114. A 75 years old man of ASA (American Society of Anesthesiologists) III status is scheduled for surgical removal of retained roots in the maxilla under IV sedation. The most appropriate statements regarding this procedure include:?

After an initial dose of midazolam, an additional dose is recommended if analgesia is inadequate

Administration of a specific analgesic agent is likely to be needed for pain

If midazolam and fentanyl are administered, then fentanyl should be given after the peak effect of midazolam is observed

Midazolam dose for elderly patient with ASA III should be reduced

115. Which one of the following statement is NOT TRUE in relation to the use oral sedation?

Patient commonly complain of post operative headache

An acceptable level of anxiolytic action is obtained when the drug is given one hour preoperatively

There is a profound amnesic action and no side affects

Oral Midazolam is considered as minimal sedation

116. Which one of the following statement is TRUE about Midazolam?

It has interaction with orange juice

Midazolam injectable solution can be mixed with sweet drinks or Paracetamol syrup

Normally, we titrate Midazolam in 5mg (5ml) increments every 5 minute while we talk to the patient

The half-life of Midazolam is 10 to 20 hours

117. Which one of the following statement is NOT TRUE about monitoring during sedation?

Pulse oximeter measures oxygen saturation in arterial blood using infrared light

Oxygen saturation (SpO2) is the amount of oxygen carried by hemoglobin, compared with the total oxygen-carrying capacity of hemoglobin; expressed as percentage

Pulse oximeter with the alarm set is better than the finger-clip without the alarm

Record pulse and oxygen saturation every 35 minutes

118. Dental extraction may be most appropriately performed under conscious sedation in the following patients:?

A patient with known allergy to local anaesthetic

A cooperative patient for extraction of four impacted wisdom teeth

A severely mentally handicapped adult

A 3-yr-old child for extraction of a single tooth

119. During a minor procedure under sedation and analgesia, the patient is breathing slowly with some snoring, is not easily aroused, and does not respond to verbal commands. At which level of sedation is this patient?

Twilight sedation

Moderate sedation

Deep sedation

Irreversible sedation

120. Which of the following defines moderate sedation?

A medically controlled state of depressed consciousness from which the patient does not respond to verbal or tactile stimuli

CNS depression produced by sedatives that allow patients to tolerate unpleasant procedures while maintaining the ability to respond to verbal or tactile stimuli

The administration of morphine to treat post-operative pain

The administration of a sedative/hypnotic agent to facilitate sleep

121. Patients being evaluated for procedure-related sedation need: ?

A history and physical

An ASA physical status assignment

A consent

all of the above

122. All of the following are monitoring requirements for the sedated patient EXCEPT?

Blood pressure

Capillary refill

Pulse oximetry

respiratory rate

123. What parameter must be monitored continuously during sedation?

State of consciousness (breathing)

Pulse oximetry

Blood pressure

Cardiac output

124. The first and most important action when a patient starts to vomit during a procedure is to?

Apply restraints

Give supplemental O2

Give a reversal agent

Reposition to lateral decubitus

125. The first response for an obstructed airway is to: ?

Suction the patient

Tntubate the patient

Insert an oral airway

Perform a chin lift/neck extension

126. Guidelines for patients at discharge after sedation should include: ?

Written release of the hospital from responsibility

Discussion of all potential adverse effects of moderate sedation

Discussion of the effects of sedation and a warning about operating a motor vehicle

A mandatory follow-up visit with the physician who performed the procedure

127. Which of the following statements about the use of benzodiazepines for moderate sedation is true?

Adjustment in dosing is needed when giving an opioid

Should always be reversed by flumazenil

Should always be reversed by naloxone

Should always be given by the oral route

128. Infants and small children are particularly susceptible to complications during sedation. The unique anatomy of which body system contributes to this susceptibility:?

Neurological

Gastrointestinal

Respiratory

Renal

129. A Post-Anesthesia Recovery Score is: ?

An objective measure used to determine a patient's suitability for discharge

The same as an ASA Physical Status Classification

A neurological assessment of LOC

A physician test of how well a patient will tolerate narcotics

130. When can the patients be discharged to home after procedure-related sedation?

After they can walk

After they can drink water

After all the vital signs have returned to normal

All of the above

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