Post on 21-Dec-2015
Oral SedationOral Sedation
Oldest and most common routeOldest and most common route
Used for stress reduction, pre- & post-op painUsed for stress reduction, pre- & post-op pain
Advantages of Oral SedationAdvantages of Oral Sedation
Universal acceptanceUniversal acceptance
Ease of administrationEase of administration
Low costLow cost
Low incidence / severity of adverse reactionsLow incidence / severity of adverse reactions
No needles, syringes or specialized trainingNo needles, syringes or specialized training
Disadvantages of Oral SedationDisadvantages of Oral Sedation
Reliance on patient complianceReliance on patient compliance
Long latent period (30-60 min)Long latent period (30-60 min)
Unreliable drug absorption in GI tractUnreliable drug absorption in GI tract
Inability to titrate effectInability to titrate effect
Prolonged duration of actionProlonged duration of action
Use of Oral SedationUse of Oral Sedation
Sedation the night before treatment to ensure Sedation the night before treatment to ensure restful sleeprestful sleep
Light levels of sedation for preoperative Light levels of sedation for preoperative anxiety reductionanxiety reduction
Oral SedativesOral Sedatives
Sedative-HypnoticsSedative-Hypnotics
Ethyl alcohol,Barbiturates,NonbarbituratesEthyl alcohol,Barbiturates,Nonbarbiturates
Antianxiety drugsAntianxiety drugs
AntihistaminesAntihistamines
Opioid analgesicsOpioid analgesics
Sedative-HypnoticsSedative-Hypnotics
Produce either sedation or hypnosis Produce either sedation or hypnosis depending on dose and patient responsedepending on dose and patient response
Ethyl alcohol (ETOH) most commonEthyl alcohol (ETOH) most common
Sedative-HypnoticsSedative-Hypnotics
BarbituratesBarbiturates
Categorized by duration of actionCategorized by duration of action
Hangover effect commonHangover effect common
In dentistry, secobarbital or pentobarbitalIn dentistry, secobarbital or pentobarbital
NonbarbituratesNonbarbiturates
Chloral HydrateChloral Hydrate
Common in pediatricsCommon in pediatrics
Elixir in fruit juice, 40-60 mg/KgElixir in fruit juice, 40-60 mg/Kg
Antianxiety DrugsAntianxiety Drugs
Benzodiazepines most commonly usedBenzodiazepines most commonly used
Wide dosage range of therapeutic activityWide dosage range of therapeutic activity
In dentistry, diazepam or midazolamIn dentistry, diazepam or midazolam
AntihistaminesAntihistamines
Sedation and hypnosis are side effectsSedation and hypnosis are side effects
Hydroxyzine most popular in pediatric Hydroxyzine most popular in pediatric dentistrydentistry
Narcotics Narcotics
Relief of moderate to severe painRelief of moderate to severe pain
Will alter psychological response to painWill alter psychological response to pain
Can suppress anxiety and apprehension, but Can suppress anxiety and apprehension, but not very effective orally not very effective orally
Rectal SedationRectal Sedation
Seldom employed in dental practiceSeldom employed in dental practice
Indicated in patients unable or unwilling to Indicated in patients unable or unwilling to take medication orallytake medication orally
Most often used in pediatrics, for very Most often used in pediatrics, for very uncooperative childrenuncooperative children
Advantages ofAdvantages ofRectal AdministrationRectal Administration
Minimal drug side effects Minimal drug side effects
Avoidance of first-pass effect via large Avoidance of first-pass effect via large intestineintestine
No special equipmentNo special equipment
Ease of administrationEase of administration
Disadvantages ofDisadvantages ofRectal AdministrationRectal Administration
Long latent period (30 min)Long latent period (30 min)
Variable drug absorptionVariable drug absorption
InconvenientInconvenient
Possible irritation of intestinesPossible irritation of intestines
Inability to titrateInability to titrate
Prolonged duration of actionProlonged duration of action
Rectal SedativesRectal Sedatives
Barbiturates (phenobarbital, secobarbital)Barbiturates (phenobarbital, secobarbital)
Narcotics (hydromorphone)Narcotics (hydromorphone)
Promethazine (primarily for N/V)Promethazine (primarily for N/V)
Chloral HydrateChloral Hydrate
Benzodiazepines (diazepam, midazolam)Benzodiazepines (diazepam, midazolam)
IM SedationIM Sedation
Parenteral technique Parenteral technique
Avoids variable GI absorptionAvoids variable GI absorption
Most commonly used in childrenMost commonly used in children
Indications forIndications for IM Administration IM Administration
Inhalation or IV not availableInhalation or IV not available
Children with severe management problemsChildren with severe management problems
Administration of emergency drugsAdministration of emergency drugs
Administration of anticholinergics and Administration of anticholinergics and antiemeticsantiemetics
Advantages ofAdvantages ofIM AdministrationIM Administration
Short onset of action (15 min)Short onset of action (15 min)
Short maximal clinical action (30 min)Short maximal clinical action (30 min)
Patient cooperation is not essentialPatient cooperation is not essential
Reliable absorptionReliable absorption
Disadvantages ofDisadvantages ofIM AdministrationIM Administration
Long latent period (15 min)Long latent period (15 min)
Inability to titrate or reverse the drug actionInability to titrate or reverse the drug action
Prolonged duration of actionProlonged duration of action
Possibility of injury to tissue at the site of Possibility of injury to tissue at the site of injectioninjection
IM SitesIM Sites
Gluteal areaGluteal area
Ventrogluteal area (hip)Ventrogluteal area (hip)
Vastus lateralis ( thigh)Vastus lateralis ( thigh)
Mid-deltoidMid-deltoid
Complications of IM InjectionsComplications of IM Injections
HematomaHematoma
AbscessAbscess
Cyst and scar formationCyst and scar formation
Necrosis and sloughing of skinNecrosis and sloughing of skin
Complications of IM InjectionsComplications of IM Injections(cont.)(cont.)
Nerve injuryNerve injury
Intravascular injectionIntravascular injection
Air embolismAir embolism
PeriostitisPeriostitis
Determinants of IM DosageDeterminants of IM Dosage
Body weightBody weight
Degree of anxietyDegree of anxiety
Level of sedation desiredLevel of sedation desired
AgeAge
Determinants of IM DosageDeterminants of IM Dosage(cont.)(cont.)
Experience of administratorExperience of administrator
Surface area (pediatric)Surface area (pediatric)
Prior response to CNS depressantPrior response to CNS depressant
Health statusHealth status
Calculations for IM DosageCalculations for IM Dosage
Clark's RuleClark's Rule
Peds dose = Peds dose = Wt of Child (lb)Wt of Child (lb) X Adult dose X Adult dose 150 150
Young's RuleYoung's Rule
Peds dose = Peds dose = Age of Child (yr)Age of Child (yr) X Adult dose X Adult dose
Age + 12Age + 12
IM SedationIM Sedation
Various combinations, largely dependent on Various combinations, largely dependent on administrator experience and preferenceadministrator experience and preference
Demerol: Phenergan: Thorazine (2:1:1)Demerol: Phenergan: Thorazine (2:1:1)
MidazolamMidazolam
KetamineKetamine