1. Oral Sedation

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

3. Advantages of Oral Sedation
Universal acceptance
Ease of administration
Low cost
Low incidence / severity of adverse reactions
No needles, syringes or specialized training

4. 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

5. Use of Oral Sedation
Sedation the night before treatment to ensure restful sleep
Light levels of sedation for preoperative anxiety reduction

6. Oral Sedatives Sedative-Hypnotics
Ethyl alcohol,Barbiturates,Nonbarbiturates
Antianxiety drugs
Antihistamines
Opioid analgesics

7. Sedative-Hypnotics
Produce either sedation or hypnosis depending on dose and patient response
Ethyl alcohol (ETOH) most common

8. Sedative-Hypnotics Barbiturates Categorized by duration of action
Hangover effect common
In dentistry, secobarbital or pentobarbital

9. Nonbarbiturates Chloral Hydrate Common in pediatrics
Elixir in fruit juice, mg/Kg

10. Antianxiety Drugs Benzodiazepines most commonly used
Wide dosage range of therapeutic activity
In dentistry, diazepam or midazolam

11. Antihistamines Sedation and hypnosis are side effects
Hydroxyzine most popular in pediatric dentistry

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

13. Rectal Sedation

14. 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

15. Advantages of Rectal Administration
Minimal drug side effects
Avoidance of first-pass effect via large intestine
No special equipment
Ease of administration

16. Disadvantages of Rectal Administration
Long latent period (30 min)
Variable drug absorption
Inconvenient
Possible irritation of intestines
Inability to titrate
Prolonged duration of action

17. Rectal Sedatives Barbiturates (phenobarbital, secobarbital)
Narcotics (hydromorphone)
Promethazine (primarily for N/V)
Chloral Hydrate
Benzodiazepines (diazepam, midazolam)

18. Intramuscular (IM) Sedation

19. IM Sedation Parenteral technique Avoids variable GI absorption
Most commonly used in children

20. Indications for IM Administration
Inhalation or IV not available
Children with severe management problems
Administration of emergency drugs
Administration of anticholinergics and antiemetics

21. Advantages of IM Administration
Short onset of action (15 min)
Short maximal clinical action (30 min)
Patient cooperation is not essential
Reliable absorption

22. Disadvantages of IM 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

23. IM Sites Gluteal area Ventrogluteal area (hip)
Vastus lateralis ( thigh)
Mid-deltoid

26. Complications of IM Injections
Hematoma
Abscess
Cyst and scar formation
Necrosis and sloughing of skin

27. Complications of IM Injections (cont.)
Nerve injury
Intravascular injection
Air embolism
Periostitis

28. Determinants of IM Dosage
Body weight
Degree of anxiety
Level of sedation desired
Age

29. Determinants of IM Dosage (cont.)
Experience of administrator
Surface area (pediatric)
Prior response to CNS depressant
Health status

30. Calculations for IM Dosage
Clark's Rule
Peds dose = Wt of Child (lb) X Adult dose
Young's Rule
Peds dose = Age of Child (yr) X Adult dose
Age + 12

31. IM Sedation
Various combinations, largely dependent on administrator experience and preference
Demerol: Phenergan: Thorazine (2:1:1)
Midazolam
Ketamine

32. IM Sedation
The deeper the level of sedation, the more intense the monitoring
Pulse oximeter at a minimum
Pretracheal stethoscope, BP, ECG