MDA : Ch-30 DENT-215 SEEMA JAIN.

MDA : Ch-30 DENT-215 SEEMA JAIN

Principles of Pharmacology
Copyright C 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Elsevier Inc.

Introduction What is Pharmacology?
Pharmacology is derived from the prefix Pharmaco-, meaning “drug or “medicine” and the suffix –logy, meaning the “study” What is a drug? It is any chemical substance that affects biologic systems, and possesses the following characteristics; selectivity of action, reversibility of action, and certain degree of potency, and the ability to interact with a biological system.

Why dental professionals need pharmacology?
1) To obtain a health history 2) Administering drugs in the office 3) Handling emergency situations 4) Planning appointments (Asthmatic pts, diabetic pts) 5) Choosing self-medications (OTC) 6) Discussing drugs

1) Patients with systemic diseases unrelated to their dental health are often taking medication prescribed by their physician. An understanding of the actions, indication, adverse reactions, and therapeutic uses of these drugs can help determine potential effects on dental treatment. 2) Oral health care provider commonly applies topical fluoride, and in some states the hygienist administers local anesthetics and nitrous oxide, therefore you need to have a working knowledge of these drugs.

3) The ability to recognize and assist in dental emergencies requires knowledge of certain drugs.
Ex. A patient having an anaphylactic reaction needs to have epinephrine administered quickly. 4) Ex. Asthmatic patients should have afternoon appointments, Diabetic patients usually have fewer problems with a morning appointment. Patients that need to be pre-medicated with antibiotics before dental appointments (mid morning or afternoon)

5) Intelligent selection of an appropriate OTC product.
6) When drugs are discussed with either the patient or another health professional, proper terminology is needed. A knowledge of the terms used to describe adverse reactions can facilitate discussions with the patient, dentist, or physician. Ex. The term allergy can refer to true allergy (e.g., hives from codeine) or be used for side effects that would be expected (e.g., stomach upset).

Overview of Drugs Drug Derivatives
Organic: Drugs derived from living organisms such as plants or animals Inorganic: Drugs synthesized in the laboratory Identifying Drugs Chemical name: Drug’s chemical formula Generic name: Name that any business firm may use e.g. acetaminophen Brand or trade name: Registered trademark e.g. Tylenol

Naming of drugs… Generic Name Trade Name acetaminophen Tylenol
lidocaine Xylocaine, Octocaine diazepam Valium acyclovir Zovirax nystatin Mycostatin Generic Name (One): Relating to or descriptive of an entire group or class. Trade Name (Many): of the drug is also known as the brand name. This trade name, is protected by the Federal Patent Law for 17 years. Copyright C 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Elsevier Inc.

*When a particular drug is being investigated by a company, it is identified by its chemical name, which is determined by its chemical structure. Which ever pharmaceutical company discovering the drug gives the drug a trade name (e.g., Coke). This trade name, registered as a trademark under the Federal Trade-Mark-Law, is the property of the registering company. Before any drug is marketed, it is given a generic name that becomes the “official” name of the drug. This drug name is not capitalized.

Copyright C 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Elsevier Inc.

Dispensing of Drugs Drugs are classified in two categories:
Patent Medicines (over-the-counter) Drugs that can be obtained without a prescription Prescription Drugs Also referred to as “Ethical Drugs” Supplied by a pharmacist who has received a prescription

Federal regulatory agencies…
Food and drug administration (FDA) It is charged with protecting public health by ensuring that drugs are safe and pure, Agency that has to approve the marketing of drugs in US. Determines what drugs can be sold OTC as opposed to by prescription. Drugs will remain in a clinical trial until they are approved by the FDA Federal trade commission (FTC) Regulates the trade practices of drug companies and prohibits false advertising of foods, OTC and cosmetics. Chemical substances harmless, and products safe, effective, and honestly labeled for OTC.

Federal regulatory agencies…
Drug enforcement administration (DEA) To enforce the controlled substances laws and regulations of the United States and to bring to justice system, those organizations, and principal members of organizations, involved in the production and distribution of illegal drugs (narcotic, opioids etc) Responsibility of recommending and supporting enforcement programs aimed at reducing the availability of controlled substances and precursor chemicals in the domestic and international markets. Copyright C 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Elsevier Inc.

Controlled Substance Act
Drug Enforcement Agency (DEA) Scheduled Drugs: Schedule I drugs have no current accepted medical usefulness and have a high potential for abuse. E.g. LSD (lysergic acid diethylamide), Marijuana Schedule II drugs have a high potential for abuse but have accepted medical usefulness. E.g. cocaine, morphine Schedule III drugs have less abuse potential and do have accepted medical usefulness. E.g. Tylenol w/ codeine Schedule IV drugs have low abuse potential and have accepted medical use. E.g. Valium, Librium Schedule V drugs are not required to be prescribed. E.g. cough medicines

What is it that makes marijuana more frightening to the federal government than cocaine or morphine? The Drug Enforcement Administration has steadfastly, over decades, listed marijuana as a Schedule I drug, meaning that it has no medical value and that the potential for abuse is high. Cocaine and morphine, far more dangerous and habit-forming, are listed as Schedule II because they have some medical value. In June 2010, the Oregon Board of Pharmacy reclassified marijuana from a Schedule I drug to a Schedule II drug.

Copyright C 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Elsevier Inc.

Drug Reference Materials
Physicians’ Desk Reference Also referred to as the “PDR” An updated source of information supplied by drug companies about their products Available as a bound text or CD-ROM Package Inserts Information sheet describing the drug for the patient Side effects Adverse or long-term effects Precautions Contraindications Dosage and route

Drug Dosage Dosage is the amount of a drug that a patient takes.
Specific factors in determining the dosage are: Age Weight Time of day the drug is taken Drug form Patient tolerance to drug Other drugs the patient is taking

Adverse Drug Effects Side Effects Body's reaction to a drug
Allergic Reactions The body has an increased sensitivity to a substance Anaphylaxis Sudden onset of an allergic reaction to a drug Drug Tolerance Loss of effectiveness of a drug Drug Addiction Physical dependence on a certain drug

Common Side Effects of Medications
Hyperexcitability Insomnia Dizziness Drowsiness CNS effects GI disturbances (nausea,vomiting,diarrhea) Hypertension Hypotension and fainting Weight changes Appetite changes Edema Sexual dysfunction Sweating Oppurtunistic infections (yeast /fungal) Photosentivity Loss of hair Blurred vision Cardiacarrhythmia Skin changes Respiratory difficulties Copyright C 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Elsevier Inc.

What does it mean for a drug to have adverse effects?
What is the most common drug that causes an anaphylaxic reaction? (Penicillin.)

Routes of Drug Administration

Fig Routes of drug administration (From Young A, Kennedy D: Kinn’s the medical assistant: an applied learning approach, ed 9, Philadelphia, 2003, Saunders; Chester GA: Modern medical assisting, Philadelphia, 1998, Saunders; and Daniel SJ, Harfst: Mosby’s dental hygiene: concepts, cases, and competencies, 2004 Update, St. Louis, Mosby 2004)

Few ways that drugs are administered?
Oral route in the form of pills, tablets, capsules, or liquids. Topical route by applying on the surface of the mucosa or skin. Transdermal route through a patch that continuously releases a controlled quantity of a medication through the skin.

Stages of Drug Action in the Body

Drug Absorption Absorption is the process by which a drug enters the bloodstream without being chemically altered or The movement of a drug from its site of application into the blood or lymphatic system

Drug Absorption The rate at which a drug reaches it site of action depends on: Absorption - involves the passage of the drug from its site of administration into the blood. Kidney: Nearly all drugs filtered at the glomerulus Distribution - involves the delivery of the drug to the tissues

Routes of Drug Administration
Important Info The route of administration (ROA) that is chosen may have a profound effect upon the speed and efficiency with which the drug acts

The possible routes of drug entry into the body may be divided into two classes:
Enteral Parenteral

Enteral Routes sublingual - placed under the tongue
Enteral - drug placed directly in the GI tract: sublingual - placed under the tongue oral - swallowing (p.o., per os) rectum - Absorption through the rectum

Parenteral Routes Intravascular (IV, IA)- placing a drug directly into the blood stream Intramuscular (IM) - drug injected into skeletal muscle Subcutaneous - Absorption of drugs from the subcutaneous tissues Inhalation - Absorption through the lungs

Important Info The ROA is determined by the physical characteristics of the drug, the speed which the drug is absorbed and/ or released, as well as the need to bypass hepatic metabolism and achieve high conc. at particular sites

Very Important Info! No single method of drug administration is ideal for all drugs in all circumstances

Prescription Writing

Definitions of Prescription
A written direction for the preparation and administration of a remedy A summary of the diagnosis, prognosis, and treatment plan for a patient’s illness A legal document

Health Doctor's scrawl blamed for patient death http://news. bbc. co
A US jury has awarded a huge damages settlement following the death of a patient caused by illegible handwriting on a prescription. Texas-based cardiologist Dr Ramachandra Kolluru gave patient Ramon Vasquez what he said was a prescription for the angina drug Isordil. However, because of the doctor's untidy writing, a pharmacist dispensed Plendil - a high blood pressure medication - instead. In fact, the dose of Plendil was double the recommended maximum daily amount. Mr. Vasquez subsequently had a heart attack and died several days later. His family sued both the doctor and the pharmacist for negligence. The jury in the case found both equally liable, awarding a total of $450,000 in damages.

Doctors' sloppy handwriting kills more than 7,000 people annually.
It's a shocking statistic, and, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM), preventable medication mistakes also injure more than 1.5 million Americans annually. Many such errors result from unclear abbreviations and dosage indications and illegible writing on some of the 3.2 billion prescriptions written in the U.S. every year.

Joke about penmanship A joke was in circulation about a chemist who started picking up medicines on reading a personal letter of a customer who had brought it to him thinking that the chemists are capable of reading illegible writings.

Till the time you get printed prescription from your physician, a few steps worth taking:
• Try to read prescription yourself before leaving doctor’s clinic. If the medicine and dose is not clearly readable, ask the doctor to rewrite the prescription. • Ask the doctor to tell you verbally the name of medicine and dosage and compare that with what you can read on the prescription note. • Ask the chemist to read aloud the name of medicine before picking up. • Read the name of the medicine to match with the prescription. It may be time consuming but worth taking trouble.

e-Rx e-prescribing

Prescriptions Written order by a physician or dentist for the preparation and administration of a medicine by the pharmacist.

Components of Written Prescriptions
All written prescriptions should contain: Patient's full name and address Prescriber's full name, address, telephone number, and DEA number Date of issuance Signiture of prescriber Drug name, dose, dosage form, amount Directions for use Refill instructions

Sample Prescription

Prescriptions Written order by a physician or dentist for the preparation and administration of a medicine by the pharmacist. Prescription Terminology Superscription: patient name, address, date, Rx Inscription: Name and quantity of the drug Subscription: Directions for mixing the drug Signature: Instructions for the patient on how to take the drug

Fig. 30-1 Example of a prescription pad
Fig Example of a prescription pad. (Courtesy Colwell Systems, Champaign, IL.)

Components of a prescription
Superscription Rx = recipe, Latin for “take thou” Denotes paper is a prescription Rx symbol for Jupiter Patient’s name, age and address Pharmacist needs this information. Name and address required; age useful check for dosage Date Required for all prescriptions

Lotta Celiva Adult You decide (pharmacist often fills this out for you) /5/01

Components (2) Inscription
Contains the name and amount of each medication Avoid abbreviations and indicate amounts in metric

Atropine sulfate 0.4 mg Lotta Celiva Adult
You decide (pharmacist often fills this out for you) /5/01 Atropine sulfate mg

Components (3) Subscription
Directions to the pharmacist, usually only how much to dispense. The following is an exception from Accepted Dental Remedies (1937)

R Dentifrice Hardsoap, in fine powder 50 g
Precipitated Calcium Carbonate 935 g Soluble Saccharin 2 g Oil of Peppermint 4 cc Oil of Cinnamon 2 cc Methyl Salicylate 8 cc To make about 1000 g Thoroughly triturate saccharin, oils and methyl salicylate with one-half of the calcium carbonate and mix the soap with the remainder of the calcium carbonate. Mix the two powders thoroughly and pass through a fine sieve.

Atropine sulfate 0.4 mg Dispense 2 tablets Lotta Celiva Adult
You decide (pharmacist often fills this out for you) /5/01 Atropine sulfate mg Dispense 2 tablets

Components (4) Signature (Label)
Directions to the patient. What the pharmacist puts on the label. Write in English for better compliance.

Label: Take 1 tab 2 hours before dental appointment.
Lotta Celiva Adult You decide (pharmacist usually fills this out for you) /5/01 Atropine sulfate 0.4 mg Dispense 2 tablets Label: Take 1 tab 2 hours before dental appointment.

Common Prescription Abbreviations
a.a. of each a.c. before meals a.m. morning b.i.d twice a day t.i.d. three times a day q.i.d. four times a day caps. capsules disp. dispense h. hour h.s. at bedtime, hour of sleep NPO nothing by mouth p.c. after meals PO by mouth p.r.n. as needed q. every, each q.d. every day q6h every 6 hours sig. label tab. Tablet t, tsp teaspoon T, tbs tablespoon ut.dict. as directed

Some of the common latin prescription abbreviations include:
· ac (ante cibum) means "before meals" · bid (bis in die) means "twice a day" · hs (hora somni) means "at bedtime" · po (per os) means "by mouth" · pc (post cibum) means "after meals" · prn (pro re nata) means "as needed" · q 3 h (quaque 3 hora) means "every 3 hours" · qd (quaque die) means "every day" · qid (quater in die) means "4 times a day" · Sig (signa) means "write" · tid (ter in die) means "3 times a day"

Table 30-1 Common Prescription Abbreviations
Copyright C 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Elsevier Inc.

Components (5) Refill order Prescriber’s signature and address
Limited for controlled substances (0 for schedule II, otherwise up to 6). Rarely required in dentistry Prescriber’s signature and address Be sure to include DDS after name Prescriptions for controlled substances will require address and DEA number and may have to be prescribed on a special triplicate blank

Label: Take 1 tab 2 hours before dental appointment.
Lotta Celiva Adult You decide (pharmacist usually fills this out for you) /5/01 Atropine sulfate 0.4 mg Dispense 2 tablets Label: Take 1 tab 2 hours before dental appointment. Your Name, DDS No 93555 Your Name, DDS

Modifications for controlled drugs
Inscription May use trade name when much easier to write because of analgesic combinations Subscription Special technique for dosage number to avoid prescription alteration DEA number Schedule II drugs cannot be called in except for an emergency (real emergency)

Controlled Substance Prescriptions (Class = schedule)
C-I Examples -- Heroin, Marijuana, LSD C-II Examples -- Morphine, Methadone, Meperidine (Demerolâ), Codeine, Oxycodone, Mehthylphenidate (Ritalinâ) C-III Examples -- Chlorphentermine, Paregoric, Nalorphine C-IV Examples -- Choral hydrate, Phenteramine (Fastinâ), Diazepam (Valiumâ), Lorazepam (Ativanâ), Phenobarbital, Clonazepam (Klonopinâ) C-V Examples -- Cough syrus with codeine, buprenorphine

Sch-II Prescriptions Prescriber's DEA Number Not refillable
Valid six months from issuance date Must be signed by prescriber May be faxed if original prescription is presented prior to dispensing Pre-printed prescriptions are not valid No phone-in orders except for emergency dispensing Dispensing for emergency situation: a) Permits a verbal order from physician to pharmacist b) Written prescription must be delivered to pharmacist within 72 hours

Sch-III Prescriptions
Refillable up to five times in a six month period Valid twelve months from issuance date May be faxed May be given as verbal prescriptions Pre-printed prescriptions are not valid

C-V and Unscheduled Prescriptions
Unlimited refills Valid twelve months from issuance date May be faxed May be given as verbal prescriptions Pre-printed prescriptions are valid

Dispense twenty-one (21) tablets Sig: Take 1 tab t.i.d. until gone
Iva Payne Adult You decide (pharmacist usually fills this out for you) /5/01 Amoxicillin 500mg Dispense twenty-one (21) tablets Sig: Take 1 tab t.i.d. until gone Your Name, DDS No 93555 Your Name, DDS AN

Dispense twenty-four (24) tablets
Iva Payne Adult You decide (pharmacist usually fills this out for you) /5/01 Vicodin 5/500mg Dispense twenty-four (24) tablets Sig: Take 2 tab every 4-6 hr prn pain Your Name, DDS No 93555 Your Name, DDS AN

Let’s recap What part of the prescription includes the name and quantity of the drug? What part of the prescription includes the instructions for the patient about how to take the drug? What part of the prescription includes the directions for mixing the drug? Can a dental assistant prescribe medication to a patient? What is the role of the dental assistant regarding prescriptions? What does it mean to dispense “50”? What does “prn” mean for the patient as it relates to pain? What are the guidelines with respect to the telephone interaction of a dental assistant with a pharmacy? What should a dental assistant do when a pharmacist calls?

Why patients have to take pre-med before dental appointments?

Let’s think What is infective endocarditis and who is at risk for it?
What bacteria is mainly involved in infective endocarditis? How can the dental office prevent endocarditis in patients who are at risk?

Antibiotic Prophylaxis
Antibiotic prescribed to an uninfected patient to prevent bacterial colonization. Most common application is for the prevention of infective endocarditis. Bacteria is abundant in the oral cavity The antibiotic decreases the bacterial colonization or adherence.

Antibiotic Prophylaxis Recommendations

Table 30-2 Recommended Doses and Regimens for Common Antibiotics
Dental patient situation Agent Regimen Standard general prophylaxis Amoxicillin Adults: 2.0g Children: 50mg PO 1hr. Before procedure Unable to take oral medications Ampicilin Adults: 2.0g IM or IV Children: 50mg IM or IV 30 minutes before procedure Allergic to penicillin Clindamycin Adults: 500mg Children: 20mg PO 1hr. Before procedure PO: orally; IM: intramuscularly; IV: intravenously

??????? What are the three drugs used for antibiotic prophylaxis?
Why do patients need to take another drug besides amoxicillin if they are allergic to penicillin as an antibiotic premedication?

That’s It !

Anxiety and Pain Control
A technique of various psychological, physical, and chemical approaches to prevent and treat preoperative, operative, and postoperative anxiety and pain. Copyright © 2005 by Elsevier Inc. All rights reserved.

Methods of Pain Control
Anesthetic Agents (covered in DENT 112) Inhalation Sedation Antianxiety Agents Intravenous Sedation General Anesthesia Copyright © 2005 by Elsevier Inc. All rights reserved.

Inhalation Sedation Nitrous oxide/oxygen (N²O/O²) is a combination of gases the patient inhales to help eliminate fear and to help relax the patient. History Dates back to 1844 Dr. Horace Wells first used on his patients Effects Nonaddictive Easy onset, minimal side effects, rapid recovery Produces stage I anesthesia Dulls the perception of pain

Advantage of Using N²O/O²
Administration is simple and easily managed Services of anesthetist or other special personnel not necessary Excellent safety record Minimal side effects Patient awake Recovery rapid Used with all age of patients Copyright © 2005 by Elsevier Inc. All rights reserved.

Contraindications of Using N²O/O²
Pregnancy: First trimester Nasal Obstruction: Problems inhaling through the nose Emphysema: Increased O² Multiple Sclerosis: Breathing difficulties Emotional Stability: Altered perception of reality Copyright © 2005 by Elsevier Inc. All rights reserved.

Inhalation Sedation Equipment
Cylinders: Gases are dispensed from steel cylinders, which are colored green for O² and blue for N²O. N²O machines: Portable or part of the dental unit. Control valves: Control the flow of each gas. Flowmeter: Indicates the rate of flow of the gases. Reservoir bag: The two gases are combined in this bag and the patient draws on it for breathing. Copyright © 2005 by Elsevier Inc. All rights reserved.

Inhalation Sedation Equipment-cont’d
Gas hose Carries the gases from the reservoir bag to the mask or nosepiece. Masks: Supplied in sizes for adults and children The nosepiece through which the patient breathes the gases. Scavenger system Protection from the occupational risks of N²O. Copyright © 2005 by Elsevier Inc. All rights reserved.

Fig. 37-10 Portable Nitrous Oxide System Unit

Exposure to Nitrous Oxide
Used only for patient treatment. Never administered for recreational purposes. How to reduce N²O hazards to dental personnel Use a scavenger system. Use a patient mask that fits well. Discourage patients from talking. Vent gas outside the building. Routinely inspect equipment and hoses for leaks. Use an N²O monitoring badge system. Copyright © 2005 by Elsevier Inc. All rights reserved.

Patient Preparation for Inhalation Sedation
Review health history. Obtain base-line vital signs. Describe the procedure of administering the gases. Describe the use of the mask and the importance of nasal breathing. Describe the sensations that the patient will experience. Reassure the patient. Copyright © 2005 by Elsevier Inc. All rights reserved.

Assisting in the Administration of Inhalation Sedation
Start with pure oxygen while establishing the patient’s tidal volume. Slowly titrate the nitrous oxide until the desired results are achieved. Patients should refrain from talking or mouth breathing. The N²O/O² analgesia should end with the administration of 100% O² for 3 to 5 minutes. Obtain postoperative vital signs and compare them to the preoperative recordings. Copyright © 2005 by Elsevier Inc. All rights reserved.

Antianxiety Agents Patients are very nervous about a procedure.
Sedatives are the drug of choice by physicians and dentists for relief of anxiety. Criteria for Use Patients are very nervous about a procedure. Procedures are long or difficult. Mentally challenged patients. Very young children requiring extensive treatment. Copyright © 2005 by Elsevier Inc. All rights reserved.

Commonly Prescribed Sedatives
Secobarbital sodium (Seconal) Chlordiazepoxide HCl (Librium) Diazepam (Valium) Chloral hydrate (Noctec): For children Copyright © 2005 by Elsevier Inc. All rights reserved.

Intravenous Sedation-cont’d
Patient Assessment A health history, physical examination, and signed consent are performed. Baseline vital signs are taken and recorded. Oximetry and electrocardiogram are completed and recorded. Weight taken and recorded for dose determination. Copyright © 2005 by Elsevier Inc. All rights reserved.

Intravenous Sedation-cont’d
Patient Monitoring Physiologic measurements taken and recorded every 15 minutes. Level of consciousness Respiratory function Oximetry Blood pressure Heart rate Cardiac rhythm Copyright © 2005 by Elsevier Inc. All rights reserved.

General Anesthesia A controlled state of unconsciousness with a loss of protective reflexes, including the ability to maintain an airway independently and to respond appropriately to physical stimulation or verbal command. This controlled state loss of consciousness, produces stage III general anesthesia. Copyright © 2005 by Elsevier Inc. All rights reserved.

General Anesthesia-cont’d
Pharmacologic Make-up Combination of gases N²O/O² Halothane or enflurane mixtures Intravenous agents such as thiopental sodium and methohexital sodium Copyright © 2005 by Elsevier Inc. All rights reserved.

Four Stages of Anesthesia
Stage I: Analgesia The stage at which a patient is relaxed and fully conscious. Able to keep his or her mouth open without assistance and is capable of following directions. Have a sense of euphoria and a reduction in pain. Vital signs are normal. The patient can move into different levels of analgesia.

Four Stages of Anesthesia-cont’d
Stage II: Excitement The stage at which a patient is less aware of his or her immediate surroundings Starts to become unconscious The patient can become excited and unmanageable Nausea and vomiting can occur This is an undesirable stage Copyright © 2005 by Elsevier Inc. All rights reserved.

Stage III: General Anesthesia The stage of anesthesia that begins when the patient becomes calm after stage II The patient feels no pain or sensation The patient will become unconscious This stage of anesthesia can be met only under the guidance of an anesthesiologist in a controlled environment such as a hospital Copyright © 2005 by Elsevier Inc. All rights reserved.

Stage IV: Respiratory Failure or Cardiac Arrest The stage at which the lungs and heart slow down or stop functioning If this stage is not reversed quickly, the patient will die Copyright © 2005 by Elsevier Inc. All rights reserved.

General Anesthesia-cont’d
Patient Preparation Preoperative physical examination. Laboratory tests. Patient or legal guardian must sign a consent form. Preoperative Instructions Dentist will review the procedure, as well as the risks. Must not have anything to drink or eat 8 to 12 hours before receiving general anesthesia. Copyright © 2005 by Elsevier Inc. All rights reserved.

Record Keeping for Sedation Methods
Always document the following measures and observations: Review of patient’s medical history. Preoperative and postoperative vital signs. Patient’s tidal volume if using inhalation sedation. Time anesthesia began and ended. Peak concentration administered. Amount of postoperative time (in minutes) for patient recovery. Adverse events or patient complaints.

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