Hospital Patient-Difficult Patient
What kinds of patients seen in hospital setting
Elements of hospital experience What constitutes a difficult pediatric
patient Classification of sedation agents Considerations for use
ASA Classification
1_ - no systemic disease, normal healthy patient
2 - one mild systemic disease- ( cold, asthma, heart murmur)
3 -severe systemic disease that limits activity but not incapacitating
4 - incapacitating dss constant threat to life 5- moribund patient- survival without
treatment questionable
General Anesthesia - Questions ???
Kinds of individuals treatedCriteria Process an individual goes throughInduction methods Safety precautions Common complications Common post operative psychological
complications
General Anesthesia
Methods to reduce post-operative complications
Methods to decrease psychological effects
Primary goal of sedation
Facilitate provision of quality care by diminishing anxiety and managing disruptive behavior
produce a positive attitude toward dental care
General consideration
Nature of treatment challenge Planned dental procedure
durationinvasivitytechnical @ equipment
Ability of care giver to provide post-operative care
Sedation
Defn: - A controlled pharmacologically induced, minimally depressed level of consiousness
Patient retains ability to maintain a patent airway independantly and continually- intact reflexes
Responds to physical, or verbal stimulation
Sedation _Indications
Differentiate between mild conscious sedation and heavy sedation \or
Preventive - anxiolytic sedation and Management sedation
Some of the commonly used drugs in pediatrics
Nitrous oxide antihistamines - hydroxazine - vistaril anxiolytics - medazolam - valium - diazepam derivatives sedative-hypnotics - chloral-hydrate dissociatives - ketaminenarcotics - Demerol
Antihistamines
Adv.. - sedative, antihistaminic, antiemetic,
anticholinergic -
Disad. - non-analgesic, non-amnesic, non- anxiolytic
Atarax -Indications
Preschool and younger children Timid highly anxious , high strung Preventive medication Extensive amount of treatment
required
Atarax- Contraindications
Previous history of hypersensitivity glaucomaInability to obtain communication
Atarax
Dosage : .5-2.5mg\kg// 1mg/lb PO Divided dosages -
1and2 hrs prior to apt.2yr old - 20lbs - 20mg 3yr old - 30lbs -30 mg4yr old - 40lbs - 40mg5yr old - 50lbs - 50mg max dose
Hydroxazine -Atarax
Actions calming effect -sedative properties subdues exaggerated responses to
stimuli without dulling the senses antiemetic antispasmodic - acts on hypothalamus effects within 30 minutes action 3-4 hrs WIDE MARGIN SAFETY
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