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MidReal Story
Sedated
Scenario:Five young children has a dental appointment. They all are wanting to be sedated for their appointments. The first child gets nitrous oxide gas from a dental nasal mask. The second child gets halothane gas from an anesthesia mask. The third child get isoflurane gas from a dental nasal mask. The fourth child gets desflurane gas from an anesthesia mask. The fifth child gets sevoflurane gas from an anesthesia mask. All their masks has a rebreather bag attached to it. The nurse starts each child on a low dosage of their gasses. She tells them that she will constantly increase their gas dosage and squeeze their rebreather bags each time she increases their gas concentration
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Anesthesia Nurse
She is an experienced anesthesia nurse working at a pediatric dentist office. She is calm, efficient, and caring. She handles five anxious children, managing their sedation levels to ensure a smooth procedure. Her attention to detail and skill in adjusting gas dosages prevent any complications. She maintains a soothing presence, making the children feel more at ease with her gentle voice and reassuring demeanor.
David Harris
He is Rebecca's husband and their son's concerned father. He is calm, supportive, and logical. He reassures his wife during their visit to the dentist, understanding the necessity of sedation for their son's safety. His composed demeanor helps alleviate his wife's anxiety as he focuses on supporting their son throughout the procedure while maintaining open communication with Dr. Smith and the nurse.
Dr. Draper
He is a pediatrician referred by the parents of the children. He is authoritative, pragmatic, and somewhat skeptical. He reviews the medical history of each child before releasing them for dental sedation. Although he expresses some concern over the use of powerful gases, he trusts the expertise of Dr. Smith and the anesthesia team, recognizing the necessity of such measures for the children's safety during the procedure.
I was working with Dr. Smith and his dental nurse today.
There were five children all wanting to be sedated for their appointments.
The first child was a boy aged six, and he got nitrous oxide gas from a dental nasal mask.
The second child was a girl aged five, and she got halothane gas from an anesthesia mask.
The third child was a boy aged seven, and he got isoflurane gas from a dental nasal mask.
The fourth child was a girl aged six, and she got desflurane gas from an anesthesia mask.
The fifth child was a boy aged five, and he got sevoflurane gas from an anesthesia mask.
All of their masks had a rebreather bag attached to it so they could breathe in the gas and then out the gas.
I would start each child on a low dosage of their particular gas and constantly increase the dosage as their procedure went along.
Each time I increased their dosage, I would squeeze the rebreather bag attached to their mask to make sure they got the correct amount of gas.
I told all of the children that I would start them on a low dosage of gas and constantly increase the dosage as their procedure went along.
I also told them that they might feel dizzy or have hallucinations when they were given the gas.
I asked all of the parents if they wanted to stay with their child while they had their procedure done.
The first two children were already done, and I move to check on the third child.
He had been breathing in his isoflurane gas for about five minutes now.
I noticed that his rebreather bag needed a bit of a squeeze, so I did that while also increasing his gas concentration by a small increment.
The boy’s eyes widened slightly, and he started to sway in the chair.
A soft giggle came from him, and then another one that was louder.
His mother was sitting next to him, and she smiled at his reaction.
Dr. Smith stopped what he was doing to prepare for the procedure and looked up at the boy.
The dental nurse even looked up from the instruments she was preparing.
The boy continued to giggle, and it became louder as the gas took effect.
I walk over to the boy’s mother, who is watching her son with a mix of amusement and concern.
She turns to look at me, and I stand beside her chair.
"Ma’am, when the patient first starts to get sedated, the isoflurane gas can cause them to feel euphoric. This is completely normal," I say to her.
The boy continues to giggle and sway in the chair.
I reach up and adjust his nasal mask so it is more comfortable for him.
He continues to giggle as I do this.
I turn back to the mother and continue, "As you can see, the gas is taking effect. He will start to calm down soon."
The mother nods as she watches her son continue to giggle.
I turn back to the anesthesia machine and check the settings.
The mother follows me and looks at the machine.
"How does it work?"
She asks me.
I turn back to her and say, "Well, the machine delivers a precise concentration of gas to the patient. The concentration of gas can be adjusted by using this dial."
I show her the dial on the machine that controls the concentration of gas that is delivered.
"The gas flows through this tube and into the nasal mask," I say as I point out the tube that leads from the machine to the nasal mask. "The patient breathes in the gas through their nose and then exhales it through their mouth. The exhaled gas then goes into this rebreather bag."
I point out the rebreather bag that is attached to the nasal mask.
"The rebreather bag helps to conserve the gas so that it can be reused. This helps to reduce waste and keep costs down," I explain.
The mother nods as she listens intently.
"What about safety features? What happens if something goes wrong?"
She asks me.
"Well, this machine has several safety features built into it," I reply.
"For example, it has a backup power source in case of a power outage. It also has an alarm system that will alert me if there are any problems with the machine or if the patient’s vital signs change."
I show her where all of these features are located on the machine.
The mother nods again as she takes in all of this information.
"Are there any side effects?"
She asks me next. "Yes, there are some side effects associated with isoflurane gas. The most common ones include dizziness, nausea, and vomiting. Some patients may also experience hallucinations or confusion."
"Yes, but they're typically mild and temporary," I assure her, as the boy's giggles finally start to subside.
I notice that the boy’s giggles are becoming less frequent.
I look at his mother, who is sitting next to him, and I can see her tense up as she notices this too.
I place my hand on her shoulder and say, "Ma’am, the boy is just starting to fall asleep now. This is normal."
She nods as she watches her son.
I turn to the machine and check the display screen that shows the patient's vital signs.
The boy’s heart rate is steady at 80 beats per minute, his blood pressure is 120/80 mmHg, and his oxygen saturation is at 98%.
I turn back to the mother and say, "You can see from the display that all of his vital signs are within a normal range."
She nods again as she continues to watch her son.
I reach up and adjust the nasal mask so it fits more comfortably on his face.
I then turn back to the machine and make a small adjustment to the gas concentration dial.
The rebreather bag attached to the nasal mask starts to inflate and deflate with each breath that the boy takes. I continue to monitor the boy’s vital signs on the display screen.
After a few minutes, I make another small adjustment to the gas concentration dial.
The rebreather bag continues to inflate and deflate with each breath that he takes.
I watch as his head slowly starts to loll to one side, and his breathing becomes deeper and more rhythmic.
A soft snoring sound comes from him as he falls into a deep sleep.
The mother watches intently as I document his vital signs on the display screen.
I turn to check on the fourth child.
She is a five-year-old girl and is breathing in desflurane gas through an anesthesia mask that covers her nose and mouth.
Her father is sitting next to her, watching intently as she breathes in the gas.
I reach up and adjust the fit of the mask on her face, making sure it is comfortable for her.
I then squeeze the rebreather bag attached to the mask to help her breathe in more gas.
The father shifts in his seat as I do this, but he doesn’t say anything.
I continue to monitor the girl’s vital signs on the display screen.
Her heart rate is steady at 90 beats per minute, her blood pressure is 110/70 mmHg, and her oxygen saturation is at 99%.
I look over at the boy who has been sedated for a few minutes now.
He is still sleeping peacefully, and his vital signs are stable. I turn back to the girl and make a small adjustment to the gas concentration dial.
The rebreather bag attached to her mask starts to inflate and deflate with each breath that she takes.
I watch as her eyes start to blink slowly, and her small hand that is clutching a stuffed rabbit starts to loosen its grip.
The father shifts in his seat again, but he still doesn’t say anything.
I continue to monitor the girl’s vital signs on the display screen.
Her heart rate slows down slightly, and her blood pressure drops by a few points.
But her oxygen saturation remains at 99%.
I look over at the boy again, who is still sleeping peacefully.
His vital signs are still stable, and he is not showing any signs of distress.
I turn back to the girl and watch as she continues to breathe in the desflurane gas. After a few minutes, I can see that she is starting to fall asleep.
Her eyes start to close slowly, and her breathing becomes deeper and more rhythmic.
A soft snoring sound comes from her as she falls into a deep sleep.
The father leans forward, his voice barely above a whisper, "Is she going to be okay?"
I nod reassuringly, "Yes, she's just entering a deeper state of sedation, which is exactly what we want for the procedure."
He relaxes slightly in his chair and murmurs, "It's just hard to watch her like this, so vulnerable."
While I continue to monitor both children, I notice the girl shiver slightly.
I glance at her temperature reading on the machine and see that it's a bit lower than normal.
I get up and retrieve a heated blanket from the warming cabinet.
I carefully place it over her small frame, making sure not to disturb the anesthesia mask or IV line.
Her father watches intently as I tuck the corners of the blanket around her shoulders and feet, careful not to restrict the movement of her chest.
The warmth seems to help - her slight tremors cease, and her breathing becomes more regular.
I step back, ensuring everything is in place, and give the father a reassuring nod as the room settles into a calm, steady rhythm.
I pause for a moment at the anesthesia machine, making a few adjustments to her gas flow.
The father reaches out and gently brushes a strand of hair away from his daughter's face.
As he withdraws his hand, I notice it trembles slightly.
His eyes remain fixed on his child's peaceful face, watching as her small chest rises and falls beneath the warmth of the blanket.
I document her latest vitals on the chart - heart rate holding steady at 88, oxygen saturation perfect at 99%.
The constant hum of the machine fills the silence between us.
I squeeze her rebreather bag one more time, ensuring optimal gas delivery, and then step away to check on my other patients.
The father lets out a long, slow breath, his tension easing as he watches her sleep.
I walk back to check on the girl under desflurane.
She seems to be doing well, but I notice that her skin looks a bit dry.
I make my way over to the IV pole and examine the drip chamber.
The flow seems a bit slower than it should be.
I reach up and adjust the roller clamp, increasing the rate from 80 to 100 milliliters per hour.
As I do this, I watch the drops falling from the chamber into the line, making sure they are coming at a steady pace.
The father leans forward in his chair, watching me intently.
"Is everything okay?" he asks.
"Yes," I reply, "I'm just adjusting her IV flow rate. We want to make sure she's getting enough fluids while she's sedated. It will help keep her blood pressure stable."
He nods, seeming to understand.
I wait for a few minutes to make sure the new drip rate is correct, and then I walk over to check on her arm where the IV catheter enters.
The father watches silently, his eyes filled with a mix of gratitude and apprehension.
I turn to face him, a calm smile on my face.
"Everything looks good," I say, gesturing towards the monitors.
Her vitals are still strong - heart rate at 85, oxygen saturation at 99%.
I point to each number on the display as I explain them to him.
He nods, his eyes following my finger as I trace the lines of data on the screen.
I notice that her hand twitches slightly, and I see his brow furrow with concern.
"That's just a normal response to the sedation," I reassure him.
"It's nothing to worry about."
To demonstrate, I squeeze her rebreather bag once more, watching as her chest rises and falls smoothly.
The father's shoulders relax as he sees how peacefully she is breathing.
I notice that the blanket has slipped down on one side, exposing her shoulder.
I reach over and gently tug it back into place, feeling that her skin is slightly cool to the touch.
I tuck the heated blanket a bit more securely around her, careful not to disturb the placement of her IV line or the mask over her face.
The rebreather bag moves steadily with each breath as I work.
The father watches from his chair, his eyes never leaving his daughter's form.
I walk over to the vital signs monitor and check her temperature again.
It has dropped by half a degree since I last checked.
I reach down and adjust the setting on the warming blanket, increasing it by one level.
I pull up a stool next to her bed, positioning myself where I can easily reach both the monitors and her IV line.
Her father's eyes follow my movements as I check her temperature again - 36.2°C, just a bit below normal.
I adjust the setting on the heated blanket higher, and then squeeze her rebreather bag once more, watching as her chest rises and falls in a steady rhythm.
The anesthesia machine hums along beside us, its beeps punctuating the silence of the room.
I take a moment to document her vital signs in her chart: heart rate 82, oxygen 99%, blood pressure 115/75.
I lean forward to examine her hands more closely, checking for any signs of movement.
As I do, I notice that her fingers seem to be twitching slightly.
I keep my position close to the monitors, but reach over to gently lift her hand.
Her father immediately stands up, but I hold up a hand to stop him.
"Please, stay seated," I say.
"I'm just checking her muscle tone."
He nods and sits back down as I continue my examination.
The movement is subtle, but it's there - a slight flexing of her index and middle fingers against the blanket.
I make a note of this in her chart, then look up at the father once more.
"This is a good sign," I explain.
"It means that the sedation is wearing off naturally. She should start to wake up soon."
The anesthesia machine continues its steady rhythm as I prepare for her gradual awakening.
The father leans forward, his voice barely a whisper.
"Does that mean she'll be able to hear us soon?"
I nod, offering a reassuring smile. "Yes, you can start talking to her now; it might help her find her way back."
I reach for the thin hospital pillow beneath her head, noticing that it's slightly compressed on one side.
Carefully lifting her head while supporting her neck, I rotate the pillow and fluff it to distribute its padding evenly.
Her father leans closer, his voice still just above a whisper as he starts telling her about their plans for ice cream after the appointment.
I adjust the mask over her face to make sure it stays properly sealed despite the movement, then check that her IV line hasn't become tangled.
The father's voice grows steadier as he speaks, and I see the faintest flicker of her eyelids in response.
I lean forward a bit more, watching as her eyelids continue to flutter.
Her vital signs remain steady on the monitor, and I can see the rebreather bag moving in time with her breaths.
The father grips the armrest of his chair tightly, his knuckles white with anticipation.
The rebreather bag moves up and down steadily as she takes slightly deeper breaths.
I reach over to adjust the gas flow a bit lower - it's time to start weaning her off the anesthesia.
Her fingers twitch a bit more actively now, and I can see her head turning slightly towards the sound of her father's voice.
I watch as she slowly starts to open her eyes, blinking a few times before they focus.
The father leans forward, his voice filled with emotion as he speaks to her for the first time since she woke up.
"Hello there, kiddo," he says softly.
"How are you feeling?"
I lean closer to my waking patient, taking her small hand in mine.
Her fingers feel cool against my palm, and I gently squeeze them to demonstrate what I want her to do.
"Can you squeeze my hand if anything hurts?" I ask softly, keeping my voice steady and reassuring.
I watch her face closely for any signs of distress as she blinks slowly, processing my request.
Her father shifts forward in his chair, his eyes fixed intently on the scene unfolding before him.
The anesthesia machine continues its rhythmic beeping, a steady accompaniment to the quiet tension in the room.
As I monitor her vital signs on the screen, I notice her heart rate climbing slightly to 90 beats per minute, but her oxygen levels remain steady at 98%.
I feel her small fingers tighten around mine, the pressure weak but deliberate.
Her father exhales sharply at this response, leaning forward in his chair.
I maintain my hold on her hand while checking the monitors - heart rate now 92, oxygen steady at 98%.
The rebreather bag moves with her increasingly regular breathing pattern.
When I look back at her face, I notice her lips curving upward slightly, though her eyes remain heavy-lidded.
Her father reaches out to stroke her hair, his hand steadier now.
Her eyes meet mine, and in that moment, everything feels right.
I lean over my patient to check her head position, noticing her neck is slightly twisted.
Supporting her head with one hand, I slide the other beneath to grasp the pillow.
Her father watches intently as I carefully lift and rotate the pillow, making sure not to disturb the IV line or mask.
The movement causes her to stir, and she mumbles something unclear.
I pause briefly, allowing her to settle before continuing to adjust the shape of the pillow.
Once satisfied with the position, I lower her head slowly, ensuring it's properly aligned with her spine.
Her father leans in closer, his voice barely above a whisper.
"Did you say something, sweetheart?" he asks, hope threading through his words.
She blinks slowly, her voice hoarse but audible. "I... I dreamed of the garden."
I give her father a reassuring nod, and he smiles weakly.
She continues to wake up steadily, her eyes fluttering open more frequently.
I document her final vital signs - heart rate 95, oxygen 99%.
"There's another child who needs me. I'll be back to check on you soon," I explain, glancing at the clock.
Her father nods in understanding, but his eyes betray uncertainty about being left alone with his daughter.
I show him how to use the call button and point out that the monitors will alert staff to any changes in her condition.
Before leaving, I adjust the IV drip one last time and ensure her mask is secure.
Her father clears his throat, trying to sound confident. "We'll be here, waiting for you," he assures me, though his voice wavers slightly.
She turns her head slightly towards him, her eyes softening. "Daddy, I saw Mom in the garden," she whispers, her words carrying a weight that makes him freeze.
His eyes widen, and he swallows hard, struggling to maintain composure. "Did she say anything to you?" he asks gently, his voice barely steady.
I stand by the door, my hand on the handle, watching them.
She nods slowly, her voice growing stronger with each word.
"She was wearing her flowered dress and smiling. She said she's always in the garden with us."
Her father's shoulders shake as he listens, his grip on the edge of her blanket tightening.
"Did she say anything else?" he asks, his voice thick with emotion.
The girl closes her eyes for a moment before responding.
"She said she'll always be watching over us."
At this, her father presses his face into the heated blanket beside her hand, his body trembling.
I quietly check her final readings - heart rate 95, oxygen 99% - and document them in her chart.