SEMINAR

1. PHARMACOLOGICAL
METHODS OF BEHAVIOURAL
MANAGEMENT PART 3
DR KARUNA SHARMA
READER
PEDODONTICS AND PREVENTIVE
DENTISTRY

2. CONTENTS
• INTRAMUSCULAR DRUGS
• INTRAVENOUS DRUGS
• REVERSAL AGENTS
• PREANESTHETIC MEDICATION
• DRUGS USED

3. INTRAMUSCULAR
• KETAMINE
• MIDAZOLAM

4. KETAMINE
DOSE-10-50MG/ML
• KETAMINE WAS FIRST SYNTHESIZED BY PARKE-DAVIS
SCIENTIST CALVIN STEVENS IN 1970
• IT PREVENTS THE HIGHER CORTICAL CENTERS PERCIEVING
VISUAL, AUDITORY, PAINFUL STIMULI
• POTENT ANALGESIC
• IT MAINTAINS CARDIOVASCULAR STABILITY AS WELL AS
MUSCLE TONE, AIRWAY REFLEXES
• CHRONIC USE MAY LEAD TO COGNITIVE IMPAIRMENT,
INCLUDING MEMORY PROBLEMS

5. MIDAZOLAM
DOSE-1-5 MG/ML
• IT POSSESSES HYPNOTIC, ANTICONVULSANT, AND MUSCLE
RELAXANT PROPERTIES AS WELL AS BEING ANTEGRADE
AMNESIC AND ANXIOLYTIC
• GREATER POTENCY AS COMPARED TO DIAZEPAM
• RAPID ONSET OF ACTION
• LIMITATIONS- USED MAINLY FOR SHORT PROCEDURES

6. INTRAVENOUS
• PROPOFOL
• MIDAZOLAM

7. PROPOFOL
• ALSO CALLED AS MILK OF AMNESIA
• DIPRIVAN:2,6 DI-ISOPROPOPHENOL
• DOSE-2MG/KG BOLUS IV FOR INDUCTION
• IT IS A FAST ACTING SEDATIVE WITH NARROWER MARGIN OF
SAFETY i.e THE DOSE REQUIRED TO PRODUCE A SEDATIVE
EFFECT IS CLOSE TO THAT USED TO INDUCE ANESTHESIA

8. PROPOFOL
LIMITATIONS AND RISK
• RESPIRATORY DEPRESSION IN PARTICULAR IS COMMONLY
ASSOCIATED WITH PROPOFOL USE
• RARELY VOMITING DOES OCCUR AND RISK OF ASPIRATION

9. MIDAZOLAM
• MOST RAPID ONSET OF ACTION
• PERMITS TITRATION AND IS EASILY REVERSIBLE
• MAINTAINS A LINE FOR EMERGENCY DRUGS
• BEST FOR INVASIVE PROCEDURE OF SHORT DURATION
• LIMITATIONS-REQUIRES EXTENSIVE ARMAMENTARIUM
TRAINING
• PRECAUTIONS TO BE TAKEN IN SIGNIFICANT HEPATIC AND
THYROID DISEASE

10. • RECTAL, SUBMUCOSAL OR SUBCUTANEOUS ARE RARELY
USED

11. REVERSAL AGENTS
• SPECIFIC REVERSAL AGENTS EXISTS FOR BENZODIAZEPINES
AND OPIOIDS
• 1. FLUMAZENIL
• 2. NALOXONE

12. FLUMAZENIL
• IT CAN BE USED TO REVERSE THE EFFECTS OF
BENZODIAZEPINES AND SHOULD BE IMMEDIATELY AVAILABLE
WHEN USING BENZODIAZEPINES FOR SEDATION
• DOSE-0.01 MG/KG 4 TIMES AS NEEDED

13. NALOXONE
• IT IS A OPIOD ANTAGONIST AND GIVEN INTRAVENOUSLY
MOSTLY
• DOSE-0.1MG/KG FOR CHILDREN UNDER 20KG
• CHILDREN OVER 20KG IS 2 MG
• THIS DRUG IS INCREDIBLY EFFECTIVE IN REVERSING THE
DEPRESSIVE EFFECTS OF THE OPIOIDS
• SIDE EFFECT-NAUSEA

14. COMPLICATIONS
• AIRWAY OBSTRUCTION
• ANAPHYLAXIS REACTIONS
• ASPIRATION
• NAUSEA
• VOMITING

15. PREANESTHETIC MEDICATION
• IT REFERS TO THE DRUGS WHICH ARE USED BEFORE
ANESTHESIA TO MAKE IT MORE PLEASANT AND SAFE.

16. OBJECTIVES OF PREANESTHETIC
MEDICATION
• RELIEF OF ANXIETY AND APPREHENSION PREOPERATIVELY
AND FACILITATE SMOOTH INDUCTION
• SUPPLEMENT ANALGESIC ACTION OF ANESTHETICS
• DECREASE ACIDITY AND VOLUME OF GASTRIC JUICE SO THAT
IT IS LESS DAMAGING IF ASPIRATED
• ANTIEMETIC EFFECT EXTENDING TO THE POST-OPERATIVE
PERIOD

17. • SOME COMMONLY USED DRUGS FOR PREANESTHETIC
MEDICATION
• PETHIDINE (50-100MG)IM
• ANTICHOLINERGIC:ATROPINE 0.6 MG IM,IV

18. • SEDATIVE ANTIANXIETY DRUGS:
DIAZEPAM-(5-10MG)ORAL
LORAZEPAM(2MG) IM

19. • H2 BLOCKERS: RANITIDINE (150MG) ORAL