Transcript Oral Sedation

Oral Sedation
Oral Sedation
Oldest and most common route
Used for stress reduction, pre- & post-op pain
Advantages of Oral Sedation
Universal acceptance
Ease of administration
Low cost
Low incidence / severity of adverse reactions
No needles, syringes or specialized training
Disadvantages of Oral Sedation
Reliance on patient compliance
Long latent period (30-60 min)
Unreliable drug absorption in GI tract
Inability to titrate effect
Prolonged duration of action
Use of Oral Sedation
Sedation the night before treatment to ensure
restful sleep
Light levels of sedation for preoperative
anxiety reduction
Oral Sedatives
Sedative-Hypnotics
Ethyl alcohol,Barbiturates,Nonbarbiturates
Antianxiety drugs
Antihistamines
Opioid analgesics
Sedative-Hypnotics
Produce either sedation or hypnosis
depending on dose and patient response
Ethyl alcohol (ETOH) most common
Sedative-Hypnotics
Barbiturates
Categorized by duration of action
Hangover effect common
In dentistry, secobarbital or pentobarbital
Nonbarbiturates
Chloral Hydrate
Common in pediatrics
Elixir in fruit juice, 40-60 mg/Kg
Antianxiety Drugs
Benzodiazepines most commonly used
Wide dosage range of therapeutic activity
In dentistry, diazepam or midazolam
Antihistamines
Sedation and hypnosis are side effects
Hydroxyzine most popular in pediatric
dentistry
Narcotics
Relief of moderate to severe pain
Will alter psychological response to pain
Can suppress anxiety and apprehension, but
not very effective orally
Rectal Sedation
Rectal Sedation
Seldom employed in dental practice
Indicated in patients unable or unwilling to
take medication orally
Most often used in pediatrics, for very
uncooperative children
Advantages of
Rectal Administration
Minimal drug side effects
Avoidance of first-pass effect via large
intestine
No special equipment
Ease of administration
Disadvantages of
Rectal Administration
Long latent period (30 min)
Variable drug absorption
Inconvenient
Possible irritation of intestines
Inability to titrate
Prolonged duration of action
Rectal Sedatives
Barbiturates (phenobarbital, secobarbital)
Narcotics (hydromorphone)
Promethazine (primarily for N/V)
Chloral Hydrate
Benzodiazepines (diazepam, midazolam)
Intramuscular (IM) Sedation
IM Sedation
Parenteral technique
Avoids variable GI absorption
Most commonly used in children
Indications for
IM Administration
Inhalation or IV not available
Children with severe management problems
Administration of emergency drugs
Administration of anticholinergics and
antiemetics
Advantages of
IM Administration
Short onset of action (15 min)
Short maximal clinical action (30 min)
Patient cooperation is not essential
Reliable absorption
Disadvantages of
IM Administration
Long latent period (15 min)
Inability to titrate or reverse the drug action
Prolonged duration of action
Possibility of injury to tissue at the site of
injection
IM Sites
Gluteal area
Ventrogluteal area (hip)
Vastus lateralis ( thigh)
Mid-deltoid
Complications of IM Injections
Hematoma
Abscess
Cyst and scar formation
Necrosis and sloughing of skin
Complications of IM Injections
(cont.)
Nerve injury
Intravascular injection
Air embolism
Periostitis
Determinants of IM Dosage
Body weight
Degree of anxiety
Level of sedation desired
Age
Determinants of IM Dosage
(cont.)
Experience of administrator
Surface area (pediatric)
Prior response to CNS depressant
Health status
Calculations for IM Dosage
Clark's Rule
Peds dose = Wt of Child (lb) X Adult dose
150
Young's Rule
Peds dose = Age of Child (yr) X Adult dose
Age + 12
IM Sedation
Various combinations, largely dependent on
administrator experience and preference
Demerol: Phenergan: Thorazine (2:1:1)
Midazolam
Ketamine
IM Sedation
The deeper the level of sedation, the more
intense the monitoring
Pulse oximeter at a minimum
Pretracheal stethoscope, BP, ECG