Oral Sedation

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Oral Sedation
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Oral Sedation

• Oldest and most common route
• Used for stress reduction, pre- post-op pain

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Advantages of Oral Sedation

• Universal acceptance
• Ease of administration
• Low cost
• Low incidence / severity of adverse reactions
• No needles, syringes or specialized training

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Disadvantages of Oral Sedation

• Reliance on patient compliance
• Long latent period (30-60 min)
• Unreliable drug absorption in GI tract
• Inability to titrate effect
• Prolonged duration of action

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Use of Oral Sedation

• Sedation the night before treatment to ensure
  restful sleep
• Light levels of sedation for preoperative anxiety
  reduction

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Oral Sedatives

• Sedative-Hypnotics
• Ethyl alcohol,Barbiturates,Nonbarbiturates
• Antianxiety drugs
• Antihistamines
• Opioid analgesics

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Sedative-Hypnotics

• Produce either sedation or hypnosis depending on
  dose and patient response
• Ethyl alcohol (ETOH) most common

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Sedative-Hypnotics

• Barbiturates
• Categorized by duration of action
• Hangover effect common
• In dentistry, secobarbital or pentobarbital

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Nonbarbiturates

• Chloral Hydrate
• Common in pediatrics
• Elixir in fruit juice, 40-60 mg/Kg

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Antianxiety Drugs

• Benzodiazepines most commonly used
• Wide dosage range of therapeutic activity
• In dentistry, diazepam or midazolam

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Antihistamines

• Sedation and hypnosis are side effects
• Hydroxyzine most popular in pediatric dentistry

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Narcotics

• Relief of moderate to severe pain
• Will alter psychological response to pain
• Can suppress anxiety and apprehension, but not
  very effective orally

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Rectal Sedation
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Rectal Sedation

• Seldom employed in dental practice
• Indicated in patients unable or unwilling to take
  medication orally
• Most often used in pediatrics, for very
  uncooperative children

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Advantages ofRectal Administration

• Minimal drug side effects
• Avoidance of first-pass effect via large
  intestine
• No special equipment
• Ease of administration

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Disadvantages ofRectal Administration

• Long latent period (30 min)
• Variable drug absorption
• Inconvenient
• Possible irritation of intestines
• Inability to titrate
• Prolonged duration of action

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Rectal Sedatives

• Barbiturates (phenobarbital, secobarbital)
• Narcotics (hydromorphone)
• Promethazine (primarily for N/V)
• Chloral Hydrate
• Benzodiazepines (diazepam, midazolam)

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Intramuscular (IM) Sedation
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IM Sedation

• Parenteral technique
• Avoids variable GI absorption
• Most commonly used in children

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Indications for IM Administration

• Inhalation or IV not available
• Children with severe management problems
• Administration of emergency drugs
• Administration of anticholinergics and antiemetics

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Advantages ofIM Administration

• Short onset of action (15 min)
• Short maximal clinical action (30 min)
• Patient cooperation is not essential
• Reliable absorption

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Disadvantages ofIM Administration

• Long latent period (15 min)
• Inability to titrate or reverse the drug action
• Prolonged duration of action
• Possibility of injury to tissue at the site of
  injection

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IM Sites

• Gluteal area
• Ventrogluteal area (hip)
• Vastus lateralis ( thigh)
• Mid-deltoid

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Complications of IM Injections

• Hematoma
• Abscess
• Cyst and scar formation
• Necrosis and sloughing of skin

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Complications of IM Injections(cont.)

• Nerve injury
• Intravascular injection
• Air embolism
• Periostitis

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Determinants of IM Dosage

• Body weight
• Degree of anxiety
• Level of sedation desired
• Age

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Determinants of IM Dosage(cont.)

• Experience of administrator
• Surface area (pediatric)
• Prior response to CNS depressant
• Health status

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Calculations for IM Dosage

• Clark's Rule
• Peds dose Wt of Child (lb) X Adult dose
  150
• Young's Rule
• Peds dose Age of Child (yr) X Adult dose
• Age 12

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IM Sedation

• Various combinations, largely dependent on
  administrator experience and preference
• Demerol Phenergan Thorazine (211)
• Midazolam
• Ketamine

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IM Sedation

• The deeper the level of sedation, the more
  intense the monitoring
• Pulse oximeter at a minimum
• Pretracheal stethoscope, BP, ECG