Oral Sedation. Oldest and most common route Used for stress reduction, pre- & post-op pain.

Oral SedationOral Sedation

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


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


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

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


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)

Intramuscular (IM) SedationIntramuscular (IM) Sedation

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


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


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


The deeper the level of sedation, the more The deeper the level of sedation, the more intense the monitoringintense the monitoring

Pulse oximeter at a minimumPulse oximeter at a minimum

Pretracheal stethoscope, BP, ECGPretracheal stethoscope, BP, ECG

Oral Sedation. Oldest and most common route Used for stress reduction, pre- & post-op pain.

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Transcript of Oral Sedation. Oldest and most common route Used for stress reduction, pre- & post-op pain.