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Concious Sedation Pedo
Concious Sedation Pedo
Concious Sedation Pedo
SEDATION
DEFINITION:
A minimally depressed level
of consciousness that retains
the patients ability to maintain
airway independently and
respond appropriately to
physical stimulation and verbal
command.
OBJECTIVES
The patients mood should be altered.
Patient should be conscious, respond to
verbal stimuli.
Patient should be co-operative.
All protective reflexes should be intact.
Vital signs stable and normal.
Childs pain threshold should be
increased.
Amnesia should occur.
INDICATIONS:
Patients
who
cannot
cooperate
or
understand for definitive treatment.
Patient lacking cooperation because of
lack
of
psychological
or
emotional
maturity.
Patients with dental care requirements
but are fear full and anxious.
If long procedures are advocated for a
nervous and apprehensive child.
Routes of Administration
INHALATIONAL (N2O)
ENTERAL ( ORAL OR RECTAL)
PARENTERAL
-Intramuscular
- Subcutaneous
- Intranasal
- Submucosal
- Intravenous
American Society of
Anesthesiology / ASA
Classification
A.S.A. Class 1: No organic, physiologic, biochemical, or psychiatric
disturbance.
The pathologic process for which the operation is to be performed is
localized and does not entail a systemic disturbance.
A.S.A. Class 2: Mild to moderate systemic disease disturbance cause
either by the condition to be treated surgically or by other pathologic
processes:
well-controlled hypertension; and no postural hypertension
history of asthma, no wheezing on day of procedure
anemia; Hct greater or equal to 30 gm
cigarette use; without COPD problems
well-controlled diabetes mellitus;
mild obesity; 20% above ideal body weight (IBW)
age <1 year or >70 years; and pregnancy.
Mallampati System
The Mallampati system anticipates the
degree of difficulty of endotracheal
intubation from I to IV, by relating
tongue size to pharyngeal size. Patient is
examined in the sitting position, with head
in neutral position and mouth open 5060mm (2-21/2 inches) and the tongue
protruding to the maximum.
Characteristics of Potential
Difficult Airway
The following physical characteristics may indicate the
potential for difficult airway management:
Hyponathic jaw (recessed)
Hypernathic jaw (protruding)
Deviated trachea
Large tongue
Short thick neck
Protruding teeth
High arched palate
Equipment Needs
Emergency equipment, including a defibrillator, must be
immediately accessible to every location where
conscious sedation is administered. The equipment
should include, but not be limited to the following:
emergency, resuscitation, and antagonist drugs;
airway and ventilator adjunct equipment for adult and
pediatric patients;
defibrillator;
source for administration of 100% oxygen and
capability for suctioning of the patient.
Oral Route
ADVANTAGES:
Convenience
Economy
Lack of toxicity.
Often Painless
Intra muscularRoute
Advantages:
Faster absorption
Technical Advantages:It requires no special equipment
little or no patient cooperation is
required
full calculated dose can be given with
a high degree of certainty.
Disadvantages:
.
A patient who is cold or very anxious
may
experience
peripheral
vaso
constriction in the area of the injection
significantly decrease the rate of
absorption.
Biggest variable in onset is related to
where the drug is actually deposited.
Subcutaneou
s
Route
ADVANTAGES: Site:- More comfortable
and convenient for the
dentist
as well as the
patient
Disadvantages:
The rate of absorption is slower because
of lesser blood supply.
Tissue Slough: Because the drug is
deposited close to the surface of the
skin or mucosa, tissue sloughing is
possible.
Liability Costs:
Intravenous
ADVANTAGES:Route:
Titration: - Small increments of doses
may be given over a short period of time
until the desired effect is achieved
Test Dose:
Intravenous Access:
DISADVANTAGES:Intravenous Access is
difficult
Placement & maintenance of
I.V. Catheter is difficult.
Require both training &
Extensive Practice.
Agents in
Conscious
Sedation
Sedative-hypnotics.
Anti-anxiety agents.
Narcotic analgesics
Increase
pain
threshold
Anti-anxiety Drugs
Drug
Diazepam
Midazolam
Mode of
action
Effect
Decrease
the activity
of limbic
system
Decrease or
remove anxiety
in patients with
mental
retardation
Decrease
the activity
of limbic
system
Anxiolytic &
causes amnesia
Narcotic Analgesics
Drug
Mode of Effect
action
Side
effect
CONTRAINDICATI
ONS:
Chronic
obstructive
pulmonary
disorder, pregnancy, myasthenia,
epilepsy, obesity, bleeding disorders.
Uncooperative patients, unwilling,
unaccompanied.
Dental difficulties prolonged surgery,
inadequate personnel.