DAANCE Patient Assessment and Preparation 5 — Questions and Answers
Question 1: Which finding during a pre-anesthesia assessment of a pediatric patient would most warrant postponing sedation?
- Mild dental anxiety
- Active upper respiratory tract infection with productive cough (Correct answer)
- A missing primary tooth
- Weight at the 25th percentile for age
Correct answer: Active upper respiratory tract infection with productive cough
An active upper respiratory infection increases airway reactivity and secretions, significantly raising the risk of airway complications during sedation.
Question 2: A patient's health history reveals use of St. John's Wort. Why is this significant before administering sedation?
- It has no interaction with sedative drugs
- It can induce CYP3A4 enzymes, reducing effectiveness of some sedatives (Correct answer)
- It raises blood pressure unpredictably
- It directly causes respiratory depression
Correct answer: It can induce CYP3A4 enzymes, reducing effectiveness of some sedatives
St. John's Wort induces cytochrome P450 enzymes, which can accelerate metabolism of benzodiazepines and other sedatives, reducing their efficacy.
Question 3: When obtaining informed consent for sedation, which element is most essential to document?
- The dentist's preferred sedation technique
- The patient's understanding of risks, benefits, and alternatives (Correct answer)
- Insurance coverage for sedation services
- The assistant's role during the procedure
Correct answer: The patient's understanding of risks, benefits, and alternatives
Valid informed consent requires documentation that the patient understands and voluntarily agrees to the risks, benefits, and alternatives of the proposed sedation.
Question 4: A patient weighing 95 kg is scheduled for moderate sedation. Drug dosing should be based primarily on which weight measure?
- Total body weight
- Ideal body weight
- Adjusted body weight for obese patients (Correct answer)
- Self-reported weight from the health history
Correct answer: Adjusted body weight for obese patients
For obese patients, adjusted body weight is preferred for dosing many sedatives to avoid overdosing based on excess adipose tissue.
Question 5: Which pre-procedure task is the dental anesthesia assistant primarily responsible for regarding equipment?
- Selecting the sedation protocol
- Verifying that emergency drugs and resuscitation equipment are functional and accessible (Correct answer)
- Prescribing pre-operative medications
- Performing the pre-anesthesia physical examination
Correct answer: Verifying that emergency drugs and resuscitation equipment are functional and accessible
The dental anesthesia assistant's key equipment responsibility is ensuring all emergency drugs and resuscitation equipment are present, functional, and immediately accessible before sedation begins.
Question 6: A patient reports a previous adverse reaction described as 'waking up in the middle of surgery.' Which pre-anesthesia step is most relevant to this history?
- Administering a higher dose of sedative without further inquiry
- Documenting the event and discussing anesthesia awareness history with the supervising dentist-anesthesiologist (Correct answer)
- Reassuring the patient that dental sedation is different from general anesthesia
- Scheduling the patient for general anesthesia instead
Correct answer: Documenting the event and discussing anesthesia awareness history with the supervising dentist-anesthesiologist
A history suggesting anesthesia awareness must be documented and communicated to the supervising provider to inform sedation planning and monitoring strategy.
Question 7: Before starting an IV line for sedation, which patient assessment finding most directly guides selection of IV catheter size?
- The patient's age
- Visible and palpable vein quality and size (Correct answer)
- The patient's blood pressure
- The planned sedation drug
Correct answer: Visible and palpable vein quality and size
IV catheter gauge selection is based on the actual size and condition of the patient's accessible veins to ensure successful cannulation.
DAANCE Patient Assessment and Preparation 5
Which finding during a pre-anesthesia assessment of a pediatric patient would most warrant postponing sedation?