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Conscio Us Sedation: Presented By: Roshni Maurya 1 Year PGT
Conscio Us Sedation: Presented By: Roshni Maurya 1 Year PGT
Conscio Us Sedation: Presented By: Roshni Maurya 1 Year PGT
us
sedation
PRESENTED BY:
ROSHNI MAURYA
1ST YEAR PGT
INTRODUCTION
In the past decade, the use of sedatives and analgesics
to relieve pain and anxiety associated with invasive
diagnostic and therapeutic/painful procedures on
pediatric patients in
non-traditional settings (i.e., Emergency Department,
Radiology, EEG lab, etc.) has substantially increased.
Child’s eyes remain open with nystagmic gaze; may exhibit random
tonic movements of extremities.
Sedation Dissociative
Consciousness
Unconsciousness
Moderate Sedation
General Anesthesia
Continuum – Deep Sedation
Deep Sedation = a drug-induced depression of consciousness
during which patients cannot be easily aroused, but respond
purposefully following repeated or painful stimulation.
Monitoring Rescue
Skills
Guiding Principles – Supervision &
Training
The following action items are necessary to ensure safe
sedation1
Supervision & Training
Children should not receive sedative or anxiolytic
medications without supervision by medical
personnel appropriately trained & skilled in
both airway management and
cardiopulmonary resuscitation.
Do not prescribe (or encourage) any sedating
medications to be administered by the parent before
arriving at the hospital.
Conduct a thorough
presedation evaluation
for underlying conditions that
would increase
the risk ( wheezing etc.). Screen
for medications the
child takes at home and/or
allergies the child may
have.
Ensure appropriate fasting (balance the risk/benefit
Guiding Principles – Equipment &
Disposition
Equipment
Have access to all appropriate medications and
reversal agents.
Use age/size-appropriate and
functioning equipment for airway
management
& venous access.
Disposition
Ensure patient is recovered to baseline
status before discharge. Appropriately
manage pain.
Provide appropriate discharge instructions to
parent/caregiver.
Personnel & Training
Primary Practitioner:
Anticipate any/all
obstacles before the real
time occurrence.
INGESTED TIME
*In emergency situations, carefully weigh the need for immediacy with the
increased risk of pulmonary aspiration. Use the lightest effective sedation
possible.
Documentation – Before & During
Before Sedation During Sedation
Presedation health evaluation (include
initial aldrete score) On a time-based flowsheet:
Confirm staff privileges & universal
procedures (i.e., “time out”) Drug name(s) & drug
Drug calculations (include reversal calculations
agents and local anesthetics) Route
Informed consent (risks vs. benefits, Site
alternatives to planned sedation)
Time
Instructions to family: Dosage (titrated to desired
Objectives of sedation
Anticipated changes in behavior
effect)
(during & after)
Why/when to expect longer During administration, record:
observation time (drugs with long
half-lifes; severe underlying
condition; neonates/preemies, etc.)
Special transport instructions for Inspired concentrations of O2 &
children going home in car seat duration of sedating/analgesic
(child’s head positioning)
24-hour emergency phone # agents
Level of consciousness
Heart rate, respiratory rate,
Document at least once every 5 minutes until SpO2
child reaches predetermined discharge criteria Adverse events and corrective
intervention/treatment given
Documentation - After
During the recovery & discharge phase,
document the following:
Time and condition of child upon discharge
Level of consciousness
Nitrousoxide/oxygen inhalation
sedation is the most commonly
used technique in dentistry.
Equipment
Diffusion hypoxia
Vomiting
Toxicity inhibit vitamin B12dependent
enzymes (Pernicious anemia)
Reproductive Abnormalities
Commonly Used
Agents
DRUG ROUTE DOSAGE ADVANTAGE DIS – PROPERTIE
S ADVANTAGES S
Hydroxyzi Oral 0.6 mg/kg Rapidly Dry mouth, •Clinical
ne IM 1.1 mg/kg absorbed from drowsiness, effect seen in
GIT hypersensitivity 15-30 min
•Half life of 3
hours
Promethaz Oral 0.5 mg/kg Sedative and Dry mouth, •Onset – 15
ne IM 1.1 mg/kg antihistaminic Blurred to 16 mins
properties,well vision,thickenin •Metabolized
absorbed g of bronchial in liver
after oral secretions,hypo •Potentiates
ingestion -tension CNS
depressant
Diphenhy Oral 1.0 – 1.5 Absorbed GIT, Disturbed •Maximum
– IM, IV mg/kg eliminated in 24 coordination, effect in 1
dramine hours epigastric hour
distress •Metabolized
in liver
•Mild
Diazepam Oral 0.2-0.5 mg/kg Sedative and Ataxia,respirato sedative
•Lipid soluble
Rectal 0.25 mg/kg Anxiolytic, ry depression and water
IV rapidly in high doses, hours
Midazol Oral IM 0.25-1mg/kg High water Apnea, •Packed at 3.3
am 1-0.15mg/kg solubility, prolonged PH, changes
sedation in 3-5 CNS effects, to 7.4 on
min and rebound entering
recovery in 2 effect blood.
hrs ,no •Highest lipid
rebound effect solubility
,rapid •Very less half
absorption from life
GIT
Chloral Oral, 25 – 50 Commonly used Irritating to •Onset: 15-30
hydrate Rectal mg/kg fro children due gastric mins
to its well mucosa, •Half life is 8-10
known effects drowsiness hrs
Fentanyl IM, IV 0.002-0.004 Potent Respiratory •Metabolized in
Mg/kg analgesic,rapid depression liver
onset •Excreted in
urine
•Onset: 7-15
min
Ketamin IM,IV 1.5 mg/kg Potent analgesic, Gastric Safety not yet
e rapid onset: 1 distress established
min in IV and 5 ,apnea , CVS •Fast onset and
min I IM disorders, short duration
CONCLUSION
Dental Chair Anesthesia is steadily
gaining popularity
challenging, new, unexplored but promising
territory
Balancing of ‘Pros & Cons’ for:
conscious sedation,
relative analgesia or GA
Setting up the services is as such not easy,
cheap,
or frivolous and simple
Must be done by trained qualified
anesthesiologists
THANK
U!