This document discusses various methods of pharmacological behavior management for dental procedures, including conscious sedation, deep sedation, and general anesthesia. It describes different routes of administration for sedative drugs like inhalation, intramuscular, intravenous, sublingual, rectal, intranasal, and oral. Specific drugs discussed include nitrous oxide, diazepam, triazolam, midazolam, and promethazine. The history of anesthesia discovery and key figures is also summarized.
Pharmacological methods of behavioural management 1DR KARUNA SHARMA
This document discusses guidelines for conscious sedation in dentistry. It defines conscious sedation and other levels of sedation. It outlines objectives and goals of conscious sedation, as well as indications, contraindications and monitoring requirements. Patient evaluation, pre-operative preparation, personnel and equipment needs, and recovery criteria are also summarized. The document provides guidance on safely administering and monitoring conscious sedation during dental procedures.
Pharmacologic considerations in pediatric dentistryasjad ansari
This document discusses several key points regarding pharmacology considerations in pediatric dentistry:
1. Children have different anatomy, physiology, and pharmacokinetics compared to adults which impacts drug dosing and effects. Factors like organ maturation, body water content, and metabolic enzyme levels vary significantly with age.
2. Drug absorption, distribution, metabolism and excretion can all be altered in children compared to adults. This includes differences in gastric emptying, plasma protein binding, liver and kidney function.
3. Accurately calculating drug dosages for children is important due to their developing bodies. Several formulas are presented to estimate dosages based on age, weight and body surface area. Careful monitoring
The document discusses the mechanism of action of fluorides in preventing dental caries. It begins by providing background on fluorine and the structure of hydroxyapatite in enamel. It then discusses how fluoride is incorporated into enamel through different "pools" in the oral environment. The main proposed mechanisms of fluoride include increasing enamel resistance through formation of fluorapatite, enhancing remineralization, and interfering with plaque bacteria. Understanding fluoride's various modes of action helps develop more effective prevention products and programs.
This document discusses dental varnishes. It begins by defining dental varnishes as thin liquid coatings applied to teeth that harden into protective films. It notes they are usually water- or solvent-based for easy application. The document outlines the main requirements for varnishes and their purposes, including protecting teeth from decay by releasing fluoride or antimicrobials, whitening teeth, and desensitizing sensitive areas. It describes different types of varnishes and application techniques. Key varnishes discussed include fluoride varnishes like Duraphat and Carex as well as desensitizing and antimicrobial options. The document reviews advantages of fluoride varnishes and concludes by summarizing a clinical study on treating sensitivity
Nitrous oxide is commonly used in pediatric dentistry to reduce anxiety and increase pain tolerance. It works by inducing analgesia while keeping the patient conscious. When administered properly via scavenging equipment and oxygen flush, it can significantly decrease fear over multiple sessions. However, chronic exposure to nitrous oxide poses health risks, so scavenging and ventilation are important to maintain safe ambient levels below recommended limits. Complications are rare when administered carefully by trained professionals according to established guidelines.
This document discusses the scope of pedodontics. It begins by defining pedodontics as the branch of dentistry concerned with providing comprehensive dental care to children. It then discusses the stages of childhood and aims/objectives of pedodontics, which include a focus on overall health, prevention over treatment, and comprehensive oral healthcare. The document outlines the various areas and specialties within the scope of pedodontics, including restorative dentistry, oral surgery, preventive dentistry, and others. It also discusses behavior management techniques, treating special patients, diagnosis/treatment planning, preventive dentistry procedures, operative procedures, traumatic dental injuries, and the father of pediatric dentistry in India.
Pharmacological methods of behavioural management 1DR KARUNA SHARMA
This document discusses guidelines for conscious sedation in dentistry. It defines conscious sedation and other levels of sedation. It outlines objectives and goals of conscious sedation, as well as indications, contraindications and monitoring requirements. Patient evaluation, pre-operative preparation, personnel and equipment needs, and recovery criteria are also summarized. The document provides guidance on safely administering and monitoring conscious sedation during dental procedures.
Pharmacologic considerations in pediatric dentistryasjad ansari
This document discusses several key points regarding pharmacology considerations in pediatric dentistry:
1. Children have different anatomy, physiology, and pharmacokinetics compared to adults which impacts drug dosing and effects. Factors like organ maturation, body water content, and metabolic enzyme levels vary significantly with age.
2. Drug absorption, distribution, metabolism and excretion can all be altered in children compared to adults. This includes differences in gastric emptying, plasma protein binding, liver and kidney function.
3. Accurately calculating drug dosages for children is important due to their developing bodies. Several formulas are presented to estimate dosages based on age, weight and body surface area. Careful monitoring
The document discusses the mechanism of action of fluorides in preventing dental caries. It begins by providing background on fluorine and the structure of hydroxyapatite in enamel. It then discusses how fluoride is incorporated into enamel through different "pools" in the oral environment. The main proposed mechanisms of fluoride include increasing enamel resistance through formation of fluorapatite, enhancing remineralization, and interfering with plaque bacteria. Understanding fluoride's various modes of action helps develop more effective prevention products and programs.
This document discusses dental varnishes. It begins by defining dental varnishes as thin liquid coatings applied to teeth that harden into protective films. It notes they are usually water- or solvent-based for easy application. The document outlines the main requirements for varnishes and their purposes, including protecting teeth from decay by releasing fluoride or antimicrobials, whitening teeth, and desensitizing sensitive areas. It describes different types of varnishes and application techniques. Key varnishes discussed include fluoride varnishes like Duraphat and Carex as well as desensitizing and antimicrobial options. The document reviews advantages of fluoride varnishes and concludes by summarizing a clinical study on treating sensitivity
Nitrous oxide is commonly used in pediatric dentistry to reduce anxiety and increase pain tolerance. It works by inducing analgesia while keeping the patient conscious. When administered properly via scavenging equipment and oxygen flush, it can significantly decrease fear over multiple sessions. However, chronic exposure to nitrous oxide poses health risks, so scavenging and ventilation are important to maintain safe ambient levels below recommended limits. Complications are rare when administered carefully by trained professionals according to established guidelines.
This document discusses the scope of pedodontics. It begins by defining pedodontics as the branch of dentistry concerned with providing comprehensive dental care to children. It then discusses the stages of childhood and aims/objectives of pedodontics, which include a focus on overall health, prevention over treatment, and comprehensive oral healthcare. The document outlines the various areas and specialties within the scope of pedodontics, including restorative dentistry, oral surgery, preventive dentistry, and others. It also discusses behavior management techniques, treating special patients, diagnosis/treatment planning, preventive dentistry procedures, operative procedures, traumatic dental injuries, and the father of pediatric dentistry in India.
Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in children in families belonging to the low-income group, where it is seen in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother, or another intimate care provider, shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's redisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.
This document provides information on various materials used for obturation in primary teeth pulpectomy procedures. It discusses the properties, advantages and disadvantages of commonly used materials like zinc oxide eugenol, iodoform-based pastes (Walcoff paste, KRI paste, Maisto paste), Vitapex, and calcium hydroxide mixtures. It summarizes studies comparing the success rates, resorption rates, and antibacterial effects of these materials. The goal of obturation is to disinfect the root canal system and create an effective seal, while using a material that will resorb at a rate similar to root resorption in primary teeth. No single material meets all ideal criteria.
This document provides definitions and guidelines for evaluating patients for complete denture therapy. It discusses examining various aspects of the patient's personal data, medical and dental history, clinical examination including extraoral and intraoral assessment, and classification systems for residual ridges and mucosa. The evaluations are meant to thoroughly understand the patient's existing conditions and needs to determine the appropriate treatment plan and prognosis.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
Emergencies in pediatric dental practiceFatima Gilani
This document provides information and guidelines for managing medical emergencies in pediatric dental practice. It discusses the duties of dental professionals in emergencies, preparation steps like having an emergency plan and trained team. Guidelines are given for assessing the pediatric patient's position, airway, breathing, and circulation. Emergency drugs and equipment are also outlined. The document aims to help dental professionals promptly recognize and treat issues to stabilize pediatric patients until emergency services arrive.
Dental management of handicapped childrenSaeed Bajafar
This document discusses dental management of handicapped children, including those with mental, physical, medical, or social conditions that interfere with normal functioning. It outlines considerations for the initial dental visit such as medical history and discussing treatment with physicians. Common oral issues in these patients include poor hygiene, cavities, malocclusion, and parafunctional habits. Treatment must be tailored based on a patient's level of dependency, disability type, health issues, oral hygiene, and behavior. Classification systems divide patients based on specific dental problems or conditions like physical, sensory, neurological, or chronic diseases. Guidelines are provided for treating patients with mental retardation or cerebral palsy.
gingiva and periodontal problems in childrenGarima Singh
This document provides an overview of gingival and periodontal diseases in children. It begins with an introduction stating that many periodontal diseases originate during childhood, so early detection and treatment are important. It then covers topics such as the normal periodontium in children, classifications of gingival diseases including gingivitis, acute gingival diseases like herpetic gingivostomatitis, and gingival enlargement. It also discusses periodontitis, specifically aggressive periodontitis which can occur in adolescents, as well as systemic diseases associated with periodontal problems. The conclusion emphasizes that early detection and treatment of periodontal issues in children can prevent more advanced diseases and also identify underlying systemic conditions.
This document provides an overview of the process for conducting a case history, examination, diagnosis, and treatment planning for pediatric dental patients. It begins with introducing the importance of thoroughly examining child patients to establish a diagnosis and treatment plan. It then describes the specific differences between examining child and adult patients. The rest of the document outlines the various components of conducting a case history, including collecting vital statistics, chief complaints, medical/dental history, and social/habits information. It also explains how to perform a physical examination, including extraoral and intraoral assessments. The document concludes by noting the steps for developing a provisional diagnosis, conducting investigations, reaching a final diagnosis, and creating a treatment plan.
This document discusses oral habits such as thumb sucking. It defines oral habits as learned patterns of muscle contractions and classifies them in various ways, such as by pressure applied, psychological components, and whether they are useful or harmful. Common oral habits mentioned include thumb sucking, tongue thrusting and bruxism. Thumb sucking is explored in more depth, including its etiology, diagnosis, effects on teeth, and various treatment approaches like psychological therapy, reminder therapy, and intraoral appliances.
The document discusses various types of full coverage restorations for primary anterior teeth including stainless steel crowns with composite facings, composite strip crowns, polycarbonate crowns, New Millennium crowns, Kudos crowns, Pedo jacket crowns, and Artglass crowns. It describes the materials, advantages, disadvantages, and placement techniques for each type of crown. Stainless steel crowns with composite facings combine strength, durability and improved aesthetics but take longer to place. Composite strip crowns provide good aesthetics but are technique sensitive. Polycarbonate crowns and Kudos crowns are more durable alternatives that are easier to place than composite strip crowns.
This document discusses fluorides in dentistry. It describes the sources of fluoride, mechanisms of how fluoride prevents tooth decay, and methods of fluoride delivery topically and systemically. It also addresses the indications for topical fluoride use, recommended dosages of fluoride tablets/drops, and potential toxicities like dental and skeletal fluorosis from inadequate or excessive fluoride intake. When used appropriately, fluoride is an effective cariostatic agent for improving dental health.
This document provides guidance on dental management of medically compromised children, focusing on those with bleeding disorders like hemophilia. It discusses evaluating coagulation factor levels, using local anesthetics safely, replacing deficient factors, and administering antifibrinolytic drugs to prevent bleeding complications. Minor procedures may require only local measures, while more extensive work like oral surgery demands factor replacement, antifibrinolytics, and close monitoring to safely manage bleeding risks. Prevention through oral hygiene and regular cleanings can reduce need for invasive dental work in these high-risk patients.
This document provides an overview of pulpotomy procedures for primary teeth. It begins with definitions of pulpotomy and discusses the rationale, objectives, indications, contraindications and classification of different pulpotomy techniques. It then describes various medicaments that can be used, including formocresol, glutaraldehyde, calcium hydroxide, and ferric sulfate. The document outlines techniques for formocresol pulpotomy, electrosurgical pulpotomy, and laser pulpotomy. It also discusses recent concepts in pulpotomy including the use of bone morphogenetic protein and enamel matrix derivatives. The document concludes by examining reasons for failure of pulpotomy therapy.
This document outlines a treatment plan for periodontal disease. It includes 5 phases: emergency, etiotropic (non-surgical), surgical, restorative, and maintenance. The etiotropic phase involves nonsurgical therapies like scaling, root planing, and oral hygiene instruction. The surgical phase uses various periodontal surgeries to further treat pockets and furcations. The restorative phase focuses on final restorations. Lastly, the maintenance phase provides periodic recall visits to monitor the patient's condition. The overall goal is to resolve inflammation and reduce pocket depths through a coordinated approach involving multiple dental specialists.
Pit and fissure sealants are materials used to protect deep grooves and depressions on teeth from cavities. They are applied to the chewing surfaces of back teeth where plaque and food easily get trapped. Sealants work by creating a physical barrier over the pits and fissures that prevents bacteria from entering and causing decay. Proper application requires cleaning, etching, and drying the tooth surface before precisely applying the sealant material. Sealants should be checked regularly and reapplied when worn down to continue protecting teeth from cavities in the pits and fissures.
This document discusses preventive resin restorations (PRR), which involve sealing carious lesions and susceptible areas with resin to prevent further decay. PRRs are classified into three types based on the extent and depth of the lesion. Type A involves sealing shallow enamel lesions with resin or sealant. Type B uses resin filler for minimal lesions extending into dentin. Type C places a bevel and layers of resin composite to restore larger lesions extending into dentin. PRR provides advantages over traditional fillings by requiring minimal tooth preparation and sealing decay, while future replacements are less invasive than replacing fillings. Maintaining isolation from moisture is important for success.
LSTR is a new pulp therapy technique used in pediatric dentistry.
This presentation illustrated some studies which ensures the high success probability of the new technique
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
This document provides an overview of general anesthetics. It discusses the history of ether and chloroform as the first widely used anesthetics. It then covers the mechanisms of action, sites of action in the body, and cellular/molecular mechanisms of how anesthetics work. The document classifies anesthetics as inhalational agents like nitrous oxide, halothane, and isoflurane or intravenous agents like thiopental and propofol. It also discusses properties of ideal anesthetics, techniques for inhaling agents, adjunct medications, and dissociative anesthetics like ketamine. Depth of anesthesia is assessed using the Guedel classification system.
Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in children in families belonging to the low-income group, where it is seen in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother, or another intimate care provider, shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's redisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.
This document provides information on various materials used for obturation in primary teeth pulpectomy procedures. It discusses the properties, advantages and disadvantages of commonly used materials like zinc oxide eugenol, iodoform-based pastes (Walcoff paste, KRI paste, Maisto paste), Vitapex, and calcium hydroxide mixtures. It summarizes studies comparing the success rates, resorption rates, and antibacterial effects of these materials. The goal of obturation is to disinfect the root canal system and create an effective seal, while using a material that will resorb at a rate similar to root resorption in primary teeth. No single material meets all ideal criteria.
This document provides definitions and guidelines for evaluating patients for complete denture therapy. It discusses examining various aspects of the patient's personal data, medical and dental history, clinical examination including extraoral and intraoral assessment, and classification systems for residual ridges and mucosa. The evaluations are meant to thoroughly understand the patient's existing conditions and needs to determine the appropriate treatment plan and prognosis.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
Emergencies in pediatric dental practiceFatima Gilani
This document provides information and guidelines for managing medical emergencies in pediatric dental practice. It discusses the duties of dental professionals in emergencies, preparation steps like having an emergency plan and trained team. Guidelines are given for assessing the pediatric patient's position, airway, breathing, and circulation. Emergency drugs and equipment are also outlined. The document aims to help dental professionals promptly recognize and treat issues to stabilize pediatric patients until emergency services arrive.
Dental management of handicapped childrenSaeed Bajafar
This document discusses dental management of handicapped children, including those with mental, physical, medical, or social conditions that interfere with normal functioning. It outlines considerations for the initial dental visit such as medical history and discussing treatment with physicians. Common oral issues in these patients include poor hygiene, cavities, malocclusion, and parafunctional habits. Treatment must be tailored based on a patient's level of dependency, disability type, health issues, oral hygiene, and behavior. Classification systems divide patients based on specific dental problems or conditions like physical, sensory, neurological, or chronic diseases. Guidelines are provided for treating patients with mental retardation or cerebral palsy.
gingiva and periodontal problems in childrenGarima Singh
This document provides an overview of gingival and periodontal diseases in children. It begins with an introduction stating that many periodontal diseases originate during childhood, so early detection and treatment are important. It then covers topics such as the normal periodontium in children, classifications of gingival diseases including gingivitis, acute gingival diseases like herpetic gingivostomatitis, and gingival enlargement. It also discusses periodontitis, specifically aggressive periodontitis which can occur in adolescents, as well as systemic diseases associated with periodontal problems. The conclusion emphasizes that early detection and treatment of periodontal issues in children can prevent more advanced diseases and also identify underlying systemic conditions.
This document provides an overview of the process for conducting a case history, examination, diagnosis, and treatment planning for pediatric dental patients. It begins with introducing the importance of thoroughly examining child patients to establish a diagnosis and treatment plan. It then describes the specific differences between examining child and adult patients. The rest of the document outlines the various components of conducting a case history, including collecting vital statistics, chief complaints, medical/dental history, and social/habits information. It also explains how to perform a physical examination, including extraoral and intraoral assessments. The document concludes by noting the steps for developing a provisional diagnosis, conducting investigations, reaching a final diagnosis, and creating a treatment plan.
This document discusses oral habits such as thumb sucking. It defines oral habits as learned patterns of muscle contractions and classifies them in various ways, such as by pressure applied, psychological components, and whether they are useful or harmful. Common oral habits mentioned include thumb sucking, tongue thrusting and bruxism. Thumb sucking is explored in more depth, including its etiology, diagnosis, effects on teeth, and various treatment approaches like psychological therapy, reminder therapy, and intraoral appliances.
The document discusses various types of full coverage restorations for primary anterior teeth including stainless steel crowns with composite facings, composite strip crowns, polycarbonate crowns, New Millennium crowns, Kudos crowns, Pedo jacket crowns, and Artglass crowns. It describes the materials, advantages, disadvantages, and placement techniques for each type of crown. Stainless steel crowns with composite facings combine strength, durability and improved aesthetics but take longer to place. Composite strip crowns provide good aesthetics but are technique sensitive. Polycarbonate crowns and Kudos crowns are more durable alternatives that are easier to place than composite strip crowns.
This document discusses fluorides in dentistry. It describes the sources of fluoride, mechanisms of how fluoride prevents tooth decay, and methods of fluoride delivery topically and systemically. It also addresses the indications for topical fluoride use, recommended dosages of fluoride tablets/drops, and potential toxicities like dental and skeletal fluorosis from inadequate or excessive fluoride intake. When used appropriately, fluoride is an effective cariostatic agent for improving dental health.
This document provides guidance on dental management of medically compromised children, focusing on those with bleeding disorders like hemophilia. It discusses evaluating coagulation factor levels, using local anesthetics safely, replacing deficient factors, and administering antifibrinolytic drugs to prevent bleeding complications. Minor procedures may require only local measures, while more extensive work like oral surgery demands factor replacement, antifibrinolytics, and close monitoring to safely manage bleeding risks. Prevention through oral hygiene and regular cleanings can reduce need for invasive dental work in these high-risk patients.
This document provides an overview of pulpotomy procedures for primary teeth. It begins with definitions of pulpotomy and discusses the rationale, objectives, indications, contraindications and classification of different pulpotomy techniques. It then describes various medicaments that can be used, including formocresol, glutaraldehyde, calcium hydroxide, and ferric sulfate. The document outlines techniques for formocresol pulpotomy, electrosurgical pulpotomy, and laser pulpotomy. It also discusses recent concepts in pulpotomy including the use of bone morphogenetic protein and enamel matrix derivatives. The document concludes by examining reasons for failure of pulpotomy therapy.
This document outlines a treatment plan for periodontal disease. It includes 5 phases: emergency, etiotropic (non-surgical), surgical, restorative, and maintenance. The etiotropic phase involves nonsurgical therapies like scaling, root planing, and oral hygiene instruction. The surgical phase uses various periodontal surgeries to further treat pockets and furcations. The restorative phase focuses on final restorations. Lastly, the maintenance phase provides periodic recall visits to monitor the patient's condition. The overall goal is to resolve inflammation and reduce pocket depths through a coordinated approach involving multiple dental specialists.
Pit and fissure sealants are materials used to protect deep grooves and depressions on teeth from cavities. They are applied to the chewing surfaces of back teeth where plaque and food easily get trapped. Sealants work by creating a physical barrier over the pits and fissures that prevents bacteria from entering and causing decay. Proper application requires cleaning, etching, and drying the tooth surface before precisely applying the sealant material. Sealants should be checked regularly and reapplied when worn down to continue protecting teeth from cavities in the pits and fissures.
This document discusses preventive resin restorations (PRR), which involve sealing carious lesions and susceptible areas with resin to prevent further decay. PRRs are classified into three types based on the extent and depth of the lesion. Type A involves sealing shallow enamel lesions with resin or sealant. Type B uses resin filler for minimal lesions extending into dentin. Type C places a bevel and layers of resin composite to restore larger lesions extending into dentin. PRR provides advantages over traditional fillings by requiring minimal tooth preparation and sealing decay, while future replacements are less invasive than replacing fillings. Maintaining isolation from moisture is important for success.
LSTR is a new pulp therapy technique used in pediatric dentistry.
This presentation illustrated some studies which ensures the high success probability of the new technique
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
This document provides an overview of general anesthetics. It discusses the history of ether and chloroform as the first widely used anesthetics. It then covers the mechanisms of action, sites of action in the body, and cellular/molecular mechanisms of how anesthetics work. The document classifies anesthetics as inhalational agents like nitrous oxide, halothane, and isoflurane or intravenous agents like thiopental and propofol. It also discusses properties of ideal anesthetics, techniques for inhaling agents, adjunct medications, and dissociative anesthetics like ketamine. Depth of anesthesia is assessed using the Guedel classification system.
These are the pharmacological agent which when administered externally , bring loss of all five modalities of sensation with reversible loss of consciousness.
Light
Sound
Taste
Temperature/
Pressure
5. Smell
Diethyl Ether :
Physical Properties :
Colourless ,volatile liq. With pungent odour.
Boil at 350 C , vapor irritant.
Exposed in air , moisture or light , it get convert to ether peroxide and acetic aldehyde , which is irritant in nature
Highly explosive.
Stored in umber colour glass bottle covered with black paper.
10-15 % in inspired air is sufficient for induction of anaesthesia which can be maintained but 4-5 % concentration.
Pharmacological Action
Only a major portion of ether is oxidized in the body and is eliminated through the lungs .
The miscibility of drug with body fluid requires large amount of drug for induction of anesthesia and induction is slow.
Ether irritate the respiratory track and enhance the mucosal secretion.
Drug may causes laryngospasm ,Ether is also known to increase heart rate, blood pressure and blood sugar. It also causes peripheral vasodilation . Ether depresses myocardial contractility.
Advt / Therapeutic effect :
Safest agent in wide margine , also unexperienced hand.
90 mg/100 ml blood Indused anaesthesia
190 mg/100 ml bloodCauses respiratory Track
Not only safe anaesthetics but good analgesic also.
It does not interfere with uterine contractility.
Does not have any effect on liver , kidney , and heat.
No special or complicated apparatus if required.
Eeconomical agent .
This document discusses general anesthetics used for inducing and maintaining anesthesia. It describes the two main types - inhalational anesthetics like isoflurane, sevoflurane, desflurane and nitrous oxide which are used for maintenance of anesthesia, and intravenous anesthetics like propofol, thiopental and ketamine which are used for induction of anesthesia. Key factors that determine the properties of inhalational anesthetics include their blood-gas partition coefficient, which impacts induction and recovery time, and oil-gas partition coefficient, which correlates with their potency. The document also provides details on the mechanisms, advantages and side effects of various commonly used general anesthetics.
This document discusses general anesthetics used for inducing and maintaining anesthesia. It describes the two main types - inhalational anesthetics like isoflurane, sevoflurane, desflurane and nitrous oxide which are used for maintenance of anesthesia, and intravenous anesthetics like propofol, ketamine and thiopental which are used for induction of anesthesia. It also discusses principles of general anesthesia including goals, stages of anesthesia and mechanisms of action of different anesthetics.
General anesthesia involves reversible loss of consciousness and sensation. It has allowed for modern surgery by creating patient comfort, immobility, and amnesia. The first widely used anesthetics were ether and chloroform in the 1840s. An ideal anesthetic has favorable physical properties like non-flammability and biological properties like rapid onset and offset without side effects. Anesthetics are classified as inhaled gases, volatile liquids, or intravenous agents. Their mechanism of action involves modifying ion channels in the central nervous system, especially GABA receptors. Stages of anesthesia include induction, excitement, surgical anesthesia, and potentially lethal medullary paralysis. Complications can occur during or after anesthesia and include respiratory depression, arrhythmias,
General anaesthetics (GAs) are drugs which produce reversible loss of all sensation and consciousness.
The cardinal features of general anaesthesia are:
• Loss of all sensation, especially pain.
• Sleep (unconsciousness) and amnesia
• Immobility and muscle relaxation
• Abolition of somatic and autonomic reflexes.
GA was absent until the mid 1800’s
Original discoverer of GA
-Crawford long, physician from Gerogia(1842),
ETHER ANESTHESIA
. NITROUS OXIDE
- Horace wells(1844)
. GASEOUS ETHER by William T.G. Morton(1846)
. CHLOROFORM introduced by
- James simpson (1847)
METHODS OF ADMINISTRATION OF INHALATIONAL GENERAL ANAESTHETICS
OPEN METHOD: This is a simple method of administering a volatile anaesthetic.
A simple mask covered with six to ten layers of gauze, which does not fit the contour of the face is held on the face and an anaesthetic like ether, or ethyl chloride is poured on it in drops. The anaesthetic vapour, diluted with air, is inhaled through the gap between the mask and the face.
SEMI-OPEN METHOD: This method is similar to open method but the dilution with air is prevented by using either a well-fitting mask like Ogston’s mask or layers of gauze between face and the mask. A small carbon dioxide build-up occurs with this method.
SEMI-CLOSED METHOD: This method allows some rebreathing of the anaesthetic drug with the help of a reservoir but in addition, part of the volume of each succeeding inspiration is a new portion from an anaesthetic mixture. This method involves accumulation and rebreathing of carbon dioxide.
• CLOSED METHOD: This method employs the chemical agent soda lime to absorb the carbon dioxide present in the expired air. It requires the use of a special apparatus but is particularly useful when the anaesthetic agent is potentially explosive
STAGES OF ANAESTHESIA
Guedel, in 1920 outlined the four stages of general anaesthesia :
• Stage I: Stage of analgesia
• Stage II: Stage of delirium
• Stage III: Stage of surgical anaesthesia
• Stage IV: Stage of respiratory paralysis
Inadequate anaesthesia is indicated by:
Signs of ANS overactivity, such as tachycardia, rise of BP, sweating and lacrimation.
Grimacing;
Other muscle activity.
Surgical anaesthesia is indicated by:
Loss of eyelash (lid) reflex
Development of rhythmic respiration.
Deep anaesthesia is suggested by :
Depression of respiration.
Hypotension
Asystole
This document provides information on premedication. It begins with definitions of premedication and a history of its use from the 1850s when ether and chloroform were commonly used anesthetics. It describes the current practice of selective premedication before anesthesia and the aims of premedication including amnesia, analgesia, and decreasing PONV risk. Common premedication drug classes are discussed including benzodiazepines, opioids, NSAIDs, and paracetamol. Specific agents like midazolam, morphine, fentanyl, diclofenac are explained in terms of pharmacokinetics, effects, side effects and dosing. Factors to consider before premedication are also
This document provides information on drugs used for general anesthesia. It discusses the mechanism of action, stages of anesthesia, and types of anesthetic agents including inhalational anesthetics like nitrous oxide, halothane, isoflurane and intravenous anesthetics like thiopentone, propofol, benzodiazepines, ketamine, fentanyl. It also covers complications of general anesthesia and preanesthetic medications. The key points are that general anesthetics produce reversible loss of sensation and consciousness through effects on GABA receptors, different stages occur as anesthesia depth increases, and a variety of drugs from different classes are used for induction and maintenance of general anesthesia.
This document provides an overview of antipsychotic drugs. It discusses the history of antipsychotics beginning in the late 19th century. It describes first and second generation antipsychotics and provides examples of common drugs. The document defines antipsychotics and outlines their classifications. It discusses the indications, pharmacokinetics, mechanisms of action, contraindications, and side effects of antipsychotic drugs. Finally, it provides nursing implications for managing common side effects and patient education guidelines.
Anesthesia and Medication Safety 1.pptxssuser47b89a
This document discusses anesthesia and medication safety. It covers:
- How anesthesia safety has improved dramatically over the past century due to new techniques, agents, monitoring and pre-anesthesia assessment.
- The goals of anesthesia including successful recovery and absence of complications.
- Guidelines for pre-anesthesia assessment, fasting, and premedication.
- Different anesthesia techniques including general, regional and local anesthesia.
- Commonly used intravenous and inhalational agents for general anesthesia and their properties and uses.
General anesthesia in oral and maxillofacial surgeryShreya Das
This document provides an overview of general anesthesia, including:
1. The definition, introduction, and effects of general anesthesia
2. The history of development of inhalational and intravenous anesthetics
3. The stages of general anesthesia including induction, maintenance, and recovery
It also discusses the mechanism of action, pre-anesthetic evaluation, complications, and conclusion regarding general anesthesia.
This document discusses antipsychotic drugs, including their history, classification, indications, side effects, and nursing implications. It notes that the first antipsychotic drugs were discovered in the 1950s and includes a table classifying examples of first and second generation antipsychotic drugs. The document outlines the mechanisms of action, contraindications, pharmacokinetics, and important considerations for patient education when taking antipsychotic medications.
The PowerPoint is an overview of the pharmacology of anesthesia that can offer great assistance to beginner medical and nursing students who are oftentimes confused about these drugs
ANAESTHESIA: INDUCTION, MAINTENACE & REVERSAL Alex Lagoh
The document discusses induction, maintenance, and reversal of anesthesia. It describes:
- The 4 stages of anesthesia from analgesia to medullary paralysis
- Common methods of induction including intravenous and inhalational agents
- Factors that determine the minimum alveolar concentration of inhalational anesthetics
- Use of muscle relaxants during induction and maintenance
- Techniques for maintenance including inhalational and total intravenous anesthesia
- Reversal of muscle relaxation using anticholinesterase drugs and assessing neuromuscular blockade.
This document discusses various classes of antiemetic, prokinetic, and digestant drugs. It covers:
1. The mechanisms and classifications of antiemetic drugs including anticholinergics, antihistamines, neuroleptics, 5-HT3 antagonists, NK1 receptor antagonists, and cannabinoids.
2. The mechanisms and uses of prokinetic drugs like metoclopramide, domperidone, and cisapride.
3. Guidelines for using different classes of antiemetic drugs to treat conditions like nausea from cancer chemotherapy, morning sickness, and motion sickness.
Similar to Pharmacological behavior management (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. Conscious sedation
• Minimally depressed level of consciousness
that retains the patients ability to maintain an
air way independently and continuously
respond appropriately to phisical stimulation
and verbal command and that is produced by
pharmacologic or non pharmacologic method
or a combination
3. Deep sedation
• Controlled state of depressed consciousness
accompanied by partial loss of protective
reflexes including inability to respond
purposefully to verbal command and is
produced by pharmacologic or non
pharmacologic method or its combination
4. General anasthesia
• A controlled state of unconsciousness
accompanied by partial or complete loss of
protective reflexes including inability to
maintain an airway independently and
respond purposefully to physical stimulation
or verbal command and is produced by a
pharmacologic or non pharmacologic
combination
5. History
• The discovery of oxygen in 1771 by carkarl
sheele and englishman joseph priertley
• Nitrous oxide and co2 was discovered in year
1772 by joseph prietley and paved away for
humphry davy 1778 -1829 to experiment with
the inhalation effects of nitrous oxide
• In 1799 humphry davy published book titled
reasearch for chemical and philosophical
chiefly concerning nitrous oxide
6. • The first published work : “a letter suspended
animation on surgical anasthesia included by inhalating
gas(co2) was by Henry hickman -1800-1830”
• About 20 years later Gardner Q cotton a travelling
lecturer of chemistry gave a demonstration of the
inhalation effects of No2 at Hartford
• A local dentist Horace wells (1815-1848) was at his
demonstration and noticed
• Several months later Horace wells demonstrated his
inhalation and extraction procedure at harvard medical
school
7. • Cotton reestablished its clinical usefulness in
dentistry in 1863
• The name anasthesia as suggested by Holmes
had been used by Plato in 400b.c to describe the
absence of feelings in a philosophical sense
• In 1st century A.D Dioscorides also used the term
to denote the absence of physical sensation
• William T.G moratn and Horace wells discoveres
of ansthesia
8. • But in 1870 the american medical association followed
suit and resolution and passed the recognizing the
discovery of anesthesia by Horace wells
• Mortan fought Bitterly seeking to obtain recognition as
the founder of anesthesia
• Mortan died of a cerebral hemorrhage in 1868
discouraged and disappointed man
• His Tombsdone reads “inventor and revealer
inhallation ansthesia before whom, in all times, surgery
was agony by whom pain in surgery was averted and
allulled since whom science has control of pain
9. • Horace wells commited sucide while he was in jail by
cutting the fumeral artety in his left thigh with a rasor
• In 1868 Admund andrew M.D of chigago illinorn
combined o2 with No2
• He is also given credit for inventing the first pratical
machine for giving No2 and O2 in fixed proportion
(1887)
• Eimckesson M.D of toledo(1881-1935) ohio classified
signs of anasthesia with No2 and O2 and desined and
manufactured the mckeeson anasthtic machine
10. • Dr.scldin describes the ways in which the drug
was used in 1940
1. Pure No2 with the exclusion of the air or O2
usulally referred to as straight No2
2. Its procedure is also termed as blue gasing
3. No2 with air
4. No2 with O2
11. • By the year 1918 the four major manufactures
of anesthesia devices in U.S were mckesson,
connell, vonforegger and herdrink
12. Inhalation sedation
• NITROUS OXIDE: is a colorless sweet smelling gas with
a density of 1.5
• The gas is marketed in steel cylinder compressed to a
pressur of 50 atmospheres and is in a liquid sate
• Upon its release from a cylinder it revert to a gaseous
state
• No2 is not explosive or flammable but it will support
comblusion of flammable materials as actively as O2
• At lower con. It has wide spread application in
analgesia techniques utilized during child delivery and
dental treatment
13. • Inhalation: ______________ and aerosols are
rapidly absorbed across the pulmonary
epithelium. Conscious sedation by the inhalation
route is accomplished by the administration of
nitrous oxide and oxygen
• The onset of action depends on;
• Concentration of the gas being administered
• The rate of alveolar ventilation
• The solubility of the gas in blood other gases used
are
14. • Intramuscular
• The intramuscular technique has the advantage of
a more predictable uptake of drug a more rapid onset
of action compared with the oral route. Drugs in
aqueous solution are absorbed well. It is used in
patients who are incapable of cooperating.
•
• Disadvantage:
• Prolonged duration of action
• Potential for tissue damage
• Onset of action: Within 15 minutes
15. • Intravenous: It is the most effective means to
achieve conscious sedation deep sedation or
general anaesthesia for any patient. Drug is
administered directly into the blood stream.
•
• Advantages: Rapid onset of action
16. • Presence of a patient intravenous line is
extremely valuable in the management of an
emergency.
•
• Disadvantage: Rapid onset of action may
increase the likelihood of overdose or adverse
effects if titration is carried out too quickly.
17. • Sublingual: The sublingual route is restricted to
those drugs available for absorption under the
tongue.
• Advantage: More rapid absorption and not ____
first pass metabolish from the liver
• There may be a large difference in recommended
doses when comparing oral with sublingual
absorption depending on the extent of the first
pass effects of the drug.
• Action within in minutes
18. •
• Rectal: The rectal route has been used in
pediatric patients but rare in adults. Through
rectal route it is assumed that 50% of the
absorbed drug bypasses the liver.
•
• Disadvantage: Inconsistencies in bioavailability, a
partial first pass effects, potential for irritation to
mucosa and inconvenience.
•
19. • Intranasal: The intranasal route is a topical
application to the nasal mucosa and as such
has rapid absorption and should have a rapid
onset of action.
•
• Disadvantages: Discomfort, variable
absorption making dose determination
difficult and potential for damage to the nasal
mucosa.
20. • Submucosal: The submucosal route of
administration is analogous to the
subcutaneous injection except it comprises
the intraoral injection of sedative drugs. It
shares many of the same characteristics as the
intramuscular route.
•
21. • Oral sedation
• Indications:
• Major indication for oral sedation s management
of patient anxiety during a dental procedure.
• It also used to facilitate venipuncture for
intravenous sedation or general anesthesia.
• Managing preoperative anxiety, either for the
night before the dental procedure when it is
believed that the patient may not be able to
obtain adequate slap.
22. • Contraindication:
• It arises if the medical history and physical
assessment determine that the patient is at
high risk for sedation.
• In mentally challenged or has dementia and in
unwilling to take an oral medication
• Pregnancy is a relative contraindication
23. • There are relatively few drug groups that are
recommended for oral sedation. They are;
• Benzodiazepies
• Antihistamines
• Alcohold
• Other agents
24. • Diazepam: Diazapam was synthesized in 1961 and is a
crystalline solid.
• Because of its sedative effect, diazepam is used to
relieve anxiety associated with all varieties of necrosis
and anxiety states.
• It has also been used in the treatment of alcoholism,
epilepsy, labour, tetanus and cerebral palsy.
• It is frequently used prior to surgery and dental
treatment because of sedation and amnesia produced.
• Also of interest to the dentist its effectiveness in
relieving sparticity and _______ in patients with
cerebral palsy.
25. •
• Action: Diazapam is an antianxiety drug which
produces sedation through its depressant effect
on the brain stem reticular system and on the
limbic system, thalamus and hypothalamus.
•
• Drug is also a muscle relaxant and has
anticonvulsant properties.
•
• Absorption and extretion:
26. • Administered
• Orally
• Intramuscularly
• Intravenously
•
• Absorption from GIT and injection site
• Peak blood levels are reached in approximately one to two hours
after administration of an oral dose.
• Metabolish of diazepam includes demethylation and oxidation.
Metabolities as well as unaltered diazepam, are excreated in two
phases: a portion of the drug in excreted rapidly (half life two to
three hours) and a portion in excreted slowly (half life two to eight
days).
27. •
• Adverse reaction
• (1) Confusion (2) Nausea (3)
Headache (4) Vertigo
• (5) Increased appetite (6) Decreased salivation (7)
Jaundice (8) Neutropenia
• Of interest to the dentist are the reports of decreased
salivation and increased appetite. It is possible that
patient undergoing long term therapy with diazepam
could experience an alteration in their caries rate
because of there side effects.
29. • Toxicity of diazepam : In relatively low.
• Central nervous system depression is the
major finding in overdose cases and includes:
drowsiness, alaxia, confusion, sleep and coma.
•
• Effects on respiration, pulse and blood pressure
are minimal with overdose (400 mg) recovery
within 8 hour.
• Treatment of overdosage should include support
of respiratory and cardiovascular function.
30. • Dosage and commercial preparation
• Adult dose range from 2 mg/day for mild anxiety to 40 mg/day for
alcoholism or cerebral palsy.
• Recommended initial children’s dosage in 1.0 to 2.5 mg three to
four times daily. Dosage may be increased as needed.
• A typical intravenous or intramuscular dose of diazepam is 2 to 20
mg.
•
• The duration of action of the drug after intravenous injection is
between 30 and 60 minutes.
•
• Valium (diazepam) is supplied by Roche Laboratories in 2, 5, 10
mg tablets and as an injectable containing 5mg/ml.
31. • Clinical investigations
• Oral diazepam: Oral premedication with diazepam has
been recommended as an aid to dental treatment of
children by several clinician.
• Peabody has reported that the recommended dosage
ranging from 2 to 10 mg for children over two years of
age.
• Kurland recommends a standard dose of 15 mg for
children 6 to 12 years old. He reported that completely
untouchable patients have accepted dental treatment
one hour after oral administration.
32. • Moody has reported on 19 patients who were
evaluated as being too difficult to manage at
an initial visit. The children were administered
5mg diazepam tablet the evening before, the
morning of and 15 minute prior to an
operative visit. Moody found that 15 of the 19
children demonstrated improved behaviour
during this visit.
33. • Pautola nad Elomaa have evaluated the
effectiveness of promethazine and diazepam
as oral premedical____ in 92 apprehensive or
different to treat children between 2 and 13
year of age. The dosage range of
promethazine was 0.4 to 3.9 mg/kg of body
weight and that of diazepam was 0.2 to 0.9
mg/kg. Treatment was possible in 74% with
promethazine 70% premedicated with
diazepam.
34. • Creack has reported treating 36 patients, 23 of
whom were children between 3½ and 14 years
of age, with 0.15 mg/kg of diazepam three
times during the 24 hours preceding the
dental visit. Behaviour observed during
operative endodontic and surgical procedures
was evaluated as good in 58% of the patients,
satisfactory in 28% and unimproved in 14%.
•
35. • Intravenous diazepam:
• Diazepam was originally and intravenously in dentistry
to supplement the barbiturate in the Jorgensen
sedation technic.
• Diazepam is contraindicated in infants and that the
safety and efficacy of infectable diazepam in children
under age 12 have not been established.
• Carmichael and Macdonald have reported failure__
with an intravenous diazepam technic. They feel that
they can claim a success rate of only 66% to 70% in
using such a technic in the treatment of 7 to 16 years
old.
36. • Healy and Hamilton have presented, results on
the completed treatment of 19 children, 4 to 16
years of age, over a total of 31 visits. The children
had been judged uncooperative at an initial
examination visit. Children under 10 years of age
were given 1.0 mg of diazepam per year of age
and children over 10 years received a 15 mg dose.
All children cooperated during the I.V. injection.
The investigators report that all of the children
were administered local anesthesia with no
difficulty, whereas this had been impossible
previously.
37. • Healy and coworkers have utilized intravenous
diazepam in the treatment of 44 severely
mentally handicapped patients who had
previously required general anesthesia for
dental treatment. Eleven of there patients
were between age 5 and 14. The results
indicate that 9 of the 11 children were
extensively cooperative during dental
treatment; the other two were able to be
treated but with considerable difficulty.
38. •
• Triazolam: Provides effective anxiolysis and amnesia it
is one of drug of choice for oral sedation in dentistry.
• Action: Within 1 hour, duration of action is 2 to 3
hours, which in ideally suited for dentistry. This
duration of action increases the likelihood for the
patient being well recovered when discharged.
•
• Adult dose range from oral sedation in dentistry is
0.125 to 0.5 mg and it is available in 0.125 or 0.25 mg
tablets.
39. • Midazolam: Medazolam has wide use as a
parenteral agent but has only recently been made
available in a oral formulation in the us__.
•
• Midazolam in similar to diazepam except it is
prepared in a water soluble _____ and has a
shorts half life because its biotransformation
leads to no significant active metabolities using
the parenteral formulation, it is usually dissolved
in a sweetened vehicle to mark its better taste.
40. • Dose of 0.5 mg/kg have been used, sometimes to
a maximum of 15 mg.
• One major caution with oral midazolam is that it
does have a significant interaction with
erythromycin, leading to increased plasma levels
and therefore may potentiate the magnitude and
duration of the sedative effect. Other
benzodiazepines like flurazepam, oxyzepam,
temazepam are used for treatment of insomnia.
41. • Antihistamines: Antiagonists of the H1
histamine receptors reverse histamine in
actions and possess sedative, antiemetic, anti-
cholinergic and local anaesthetic effects.
•
• Specific H1 antagonists play a role in oral
sedation in dentistry.
• Premethazine
• Hydroxyzine
42. • Promethazine: Is a yellow, odorless, crystalline powder
which is soluble in water, it is introduced in 1946.
Promethazine hydrochloride is a phenothiazine derivative.
•
• Promethazine is used to prevent and to treat nausea and
vomiting associated with motion, pregnancy or surgical
operation.
•
• It is used prior to medical and dental procedure
because it produces sedation and will also reduce swelling,
pain and trismus that may be associated with the
treatment.
•
43. • Action, properties and effects
• Antihistamines antagonise the action of histamine in
allergic and anaphylactic reaction.
• The mechanism by which the antihistamines action the
central nervous system is unknown.
• Antihistamines may alter the responses of smooth muscle,
skin, GIT
• Effects on the central nervous system include sedation or
drowsiness and antiemetic and antimotion sickness
properties.
• Promethazine is also a potent local anesthetic
• Some anticholinergic activity also occurs, producing
dryness of the mouth.
44. • Absorption, fat and excretion
• May be given orally, rectally, intramuscularly and
IV.
• Intra arterial injections are contraindicated since spasm
of digital vessels and subsequent gangrene can occur.
• Subcutaneous injection are not recommended as
chemical irritation and local necrosis have been
reported.
• Metabolism of the drugs is often rapid and occurs
mostly in the liver, with degradation products excreted
in the urine.
45. • Adverse reaction and toxicity
• Dizziness, weakness, drymouth, nausea and
vomiting attempted suicides with promethazine have
resulted in deep sedation, coma, convulsions and
cardiorespiratory symptoms.
• Dosage and commercial preparation:
• Oral adult dose: 25 to 50 mg
• Oral children dose: 12.5 to 25 mg
• Presurgical doses for adult: 50 mg
• For children 1.1 mg/kg of body
• _______________
46. • Clinical investigation: Very few studies have been in which
promethazine is used as the role premedicating agent. In the
previously described study by Pantola and Elomaa, promethazine or
diazepam was administered as an oral premedicant to 92
apprehensive children.
•
• In another study which tests the effects of promethazine,
Jones has evaluated 100 children at an examination appointment
and at three subsequent operative appointments during which they
were premedicated with either premethazine (70 mg), recobarrbital
(80 mg) or a pla____.
•
•
47. • The drugs were administered orally in a double blind
fashion to both cooperative and uncooperative
patients 45 minutes prior to treatment.
• Jones evaluated the children’s behaviour on the bases
of cooperation, crying and apprehension at 15 minute
intervals during each visit.
•
• While promethazine elicited significantly better
behaviour than did the placebo, the behaviour
observed with the use of recobarbital was significantly
better than that obtained with promethazine.
48. • Hydroxyzine: It is a piperazine derivative which
may be prepared as either hydroxyzine
hydrochloride or hydroxyzine pamoate.
•
• Because of its antianxiety and antihistamine
properties it is also used in the treatment of
patient with allergies with emotional
components.
•
• It is also used to control nausea and vomiting,
including that associated with pregnancy and
motion sickness.
49. • Action, properties and effects:
• It suppress activity in regions of the
subcortex of the central nervous system and it
has several effects on the CNS.
• It is effective antianxiety, minimal hyp____,
primary and secondary muscle relaxation,
antispasmodic and anti_____.
• Of interest to the dentist is the mild
antisialogogue effect frequently observed with
hydroxyzine.
50. • Absorption, rats and excretion:
• Oral administration noted with 15 to 30
minutes and peak activity within one hour.
Effective duration of action is approximately 3
to 6 hours. Drug is metabolized in liver and
metabolic byproducts are excreted in the
urine.
51. • Adverse reaction and toxicity:
• Contraindicated in unknown
hypersensitivity. Contraindicated for
subcutaneous, intraarterial or intravenous use
became of reported of subsequent
endorteritis, thrombolis and digital gangrene.
•
• Dosae and commercial preparations:
• Adult dosage ranges from 25 to 100 mg
four times daily. Children ranges from 50 to
52. • Commercial preparation:
• Vistaril capsule (25, 50 and 100 mg) oral
suspension (25mg/5 ml)
• IM 25 or 50 mg/cc
• Atarax tab (10, 25, 50 and 100 mg) and
syrup (10 mg/5 cc)
•
53. • Clinical investigation:
• Steward advocates the routine use of
hydroxyzine to reduce children’s anxiety
during dental treatment. He utilize the drug in
98% of his patient and has reported on his one
of it in 2600 patients. He recommends an oral
dose of 10 to 20 mg 45 minutes prior to the
visit. Steward feels that, given either alone or
54. • in conjunction with other psychologic or
sedative techniques, hycroxyzine is a valuable
component in a total program for controlling
apprehension.
• Lang has tested the effects of hydroxyzine v/s
a placebo on 76 children 3 to 9 years of age.
The behaviour palle____ of the children were
evaluated at an initial visit and ranged from
mild apprehension to severe cooperation
difficulty. The medications a placebo or 50 mg
55. • Alcohols: There are only two representative
drugs from the alcohols group.
• (1) Chloral hydrate (2) Ether
• Chloral hydrate: Used in pediatric dentistry. It
is well absorbed, duration of action ranging
from 4 to 8 hours. Its mechanism of action is
by active metabolite, trichloroethanol, which
induces central nervous sysem depression.
•
56. • Adverse effect includes: Gastric upset, nausea,
vomiting and flatulence.
•
• Contraindicated in: Hepatic impairment, several
renal impairment, severe gastritis, gastric ulcers,
cardiac diseases. If patient is one anticoagulants
(if leads to displacement of plasma protein).
•
• Chloral hydrate is usually administered in the
form of an e____, recommended dose of 40 to 50
mg/kg. When administered alone, not to exceed
1500 mg. It is available as either 250 or 500 mg
57. • Ethchlorvynol: Anticonvulsant and muscle
relaxant properties rapidly absorbed
duration of action 5 hour.
• Adverse effect: Unpleasant taste, dizziness,
nausea, vomiting, hyp____,
• Contraindicated: Hepatic or renal dysfunction.
• Recommended dosage from 200 to 1000 mg.
• It is available as 200, 500 or 750 mg capsules.
58. • Other agents: Like ketamine, opioids,
barbiturates.
• Ketamine: Mainly given IM (10 and 50 mg/ml)
• It is potent analgesic, potential for oral
use.
• Oral dose 6 mg/kg. It induces deep
sedation.
•
• Opiods: There analgesic are effective in
inducing sedation when given IV.
59. • Meperidine (Demerol) is commonly used.
•
• Barbiturates: Barbiturates are no longer drugs
of choice to induce oral sedation.
• Barbiturates has low therapeutic index
• Barbeturates like, secobarbital and
pentobarbital
60. • The dose for drugs described in the
pharmacology section are estimates assuming
the patient is a healthy 70 kg adult. There are
factors that can modify these
recommendations and lead to adjustment of
the dose above or below those suggested.
61. • These factors are as follows;
• Body weight or body surface area
• Extremies of age
• Medical history
• Concurrent medication
• Presence of chemical dependency
• Level of anxiety
•
62. Use of NO2
• Physiology : No2 doesnt enter into chemical
combination with any body tissue depression
of the CNS
• It doesn’t compete with the O2 and CO2
• Approximately 100ml of blood will dissolve in
its plasma about 45ml of NO2
• Its mode of action is directly proportion to this
type of solubility
• The partial pressure of inhalled NO2 that
arrives in the lung alveoli are a deteminant
tension of this gas in the blood
63. • Therefore the amount of NO2 absorbed from
the lungs relative to the NO2 tension and
partial pressure in the blood
• Pharmacological action: NO2 is an inorganic
gas which is capable of producing anesthetic
properties
• Its anesthetic action is related to its great
solubility in the blood plasma 100ml of blood
will dissolve 45ml of NO2
• Depression of the CNS
64. • Pharmacological effect: NO2 has been
demonstrated to affect all sensations such as
hearing, sight, touch and pain
• Eckenhoff reported that NO2 doesn’t cause
any appreciable changes in cardiac rate or
cardiac output
• Clinically venodialation has been reported
with inhalation of moderate concentration of
NO2
• NO2 in the absence of hypoxia or hypercarbia
65. • Bllod volume and composition are not altered
by the administration of NO2
• It has been reported that those patients with
the sickle cell traits can be develop a sickling
crises as a result of hypoxia rather than as the
effect of NO2
• NO2 decrease the sensitivity of the oral, nasal
larngo tracheal areas
• Larngospasm hazard has also been reported
66. • Stage 1: analgesia is defined as variable
degrees of pain relief with consciousness.
• As analgesia depress, pain sensation can be
lost however the sense of touch is not always
obtunded.
1. The extraction of a tooth
2. Incision with the scalpel
3. Removal of the dental pulp may produce pain
67. • Stage 2: excitement stage: in this stage the
patient is unconscious and the inhibitory
center is released , thereby producing the
manifestations of exaggerated refluxes
• Stage 3: surgical anasthesia: the patient is
unconscious with muscular responses present
• Parbrooks demonstrated that the analgesia
effect of NO2 is greater if the patient receives
a narcotic prior to analgesic administration
68. • The use of atropine should be avoided
because of an anti analgesic action that may
require higher ion concentration of NO2
• Concentration of 20 % NO2 have similar
potency with 15mg of morphine
69. Analgesia or anasthesia
• At concentration of 45-65% there is occasional
nausea and vomiting a 80 % NO2 this problem
increases
• When the concentration reaches or
approaches 80% the patient may slide from
analgesia into anesthesia
• As the duration of the procedure is extended
there may develop a vacillation between the
analgesia and anesthesia stages which may
not be detected by the anesthesia dentist
• In the recovery period following NO2
70. Analgesia and anesthesia
• The term analgesia which is defined as a state
of pain relief without the loss of counciouness
• E.I Mckesson M.D he realized that the classical
stage of ether Guedal didn’t apply to NO2
anesthesia
• Mckenssons classification for stages of NO2
71. Analgesia in dentistry
• Concentration of 6-25% NO2 plus O2 produce
the effect of analgesia and certain restorative
dental procedures may be performed
• Operative dentistry we may suppress the
painful experience with a 50:50 combination
of O2 and NO2
• Pessson in 1951 showed that with 40% NO2
and 60% O2 inhaled for 3 minutes, adequate
analgesia for cavity preparation could be
develop
• Ruben in 1966 showed that in concentration
72. • Lassener reported if a patient is encouraged
during the induction phase to tolerate some
of the painful sensations
• Patient who are apprehensive, extremely
fearful of the dental procedure or suffering
severe pain any find concentration inadequate
73. Indications for the use of NO2 in
dentistry
1. Incision and drainage of an acute abscess
2. Where multiple operative procedures are
required and the patient is extremely
apprehensive
3. Children and adults who are unreceptive to
local anesthesia injection techniques
4. The mentally handicapped and those
patients who have a severe spastic condition
74. Contraindications to NO2 analgesia or
anasthesia
1. Trismus associated with cellulitis of the floor
of the mouth or the neck, which could
possibly embarrass the airway
2. Ingestion of food or liquid recently prior to
the administration of the anesthetic agent
3. Certain medical problems such as severe
cardiac disease, hyperthyroid, uncontrolled
diabetes, sickle cell trait, upper respiratory
infections, severe emphysema and asthmatic
problems
75. Dosage and commercial preparations
• However it is not used unusual for
concentration of 70%-85% of NO2 to be used
during induction with subsequent reduction to
a 50% or 65% concentration
• During the second stage of labor,
administration of 100% NO2 during
contraction and 100% O2
• NO2 may be purchased in either small D or E
size or large G or H size cylinders
• The larger cylinders are considerably more
76. Steps in nitrogen oxide oxygen
technique
• Preparation of equipment
• Preparation of the patient
• Introductory administration
• Administration during treatment
• Preparation of equipment: the NO2
equipment should be prepared for use before
the child is seated in the operatory
• The valves need to be opened and pressure
77. • The centralized system is convenient
• Centralized equipment is more discrete
• This is a significant advantage since many
children may become upset upon seeing a
rather large and formidable looking machine
being wheeled into the operatory with tanks
changing together
• The nasal inhaler and tubing may be the only
equipment seen by the child
• Having an assortment of nosepieces from
different manufacture is helpful in making a
78. • The nosepiece should have been washed with
soap and water after its last use and should be
wiped with scented alcohol to digene the
smell of both alcohol and the nosepiece itself
• Preparation of the patient: the child should be
seated in a reclining position
• More important that the physical preparation
of the equipment is the psychological
preparation of the child and the indroductiory
79. • Put to sleep
• Tell show do
• It is essential that all procedures and
sensation which may be experienced by the
child be described in advance
• The possible sensation of warmth tingling in
the extremities auditory changes and change
in perceived body weight
• The use of good positive descriptions will
make the most of children's susceptibility to
80. • Introductory administration: analgesia machine
delivering a flow of five liters per minute
• Nosepiece should be placed
• Graceful nonthreatening manner
• During the entire period no sudden or rapid
movements
• The child should be allowed to adjust the
nosepeice
• The nasal inhaler should fit snugly
81. • During this period the child reaction should be
carefully monitered
• Increase or decrease the concentration
• Once the desired sensations have been
obtained
• The nasal inhaler is removed before the O2 is
turned off
• the child is allowed ton return to normal
activities
82. Adminstration during treatment
• Administration during treatment: the use NO2
conscious sedation at subsequent follows the
same pattern
• Maintenance levels of NO2
• NO2 can be employed during most dental
procedures like
• It is used to allow fear of injection it doesn’t
interfere with the placement of the rubber
dam
• It is very useful during surgical procedure
• While NO2 provide analgesia it is
83. Drugs used with nitrous oxide oxygen
techniques
1. Narcotic analgesia agents
2. Ultrashort acting barbiturates
3. Other inhalation agents
4. Local anesthetic injections
1. Narcotic analgesic agents: on using these
drugs with NO2 it increase pain threshold
• Where there is a strong possibility of painful
stimuli the narcotic analgesic should be used
84. • This will give profound relief
• With the use of narcotic analgesic agents
there is a possibility of respiratory depression
this effect can be reversed by giving a narcotic
antagonist
• The most commonly used narcotic is
combination with N2O is meperidine
2. Ultrashort acting barbiturates: produces a
state of sedation
• Where as nitrous oxide oxygen produces a
85. 3. Other inhalation agents: halothane with
nitrous oxide oxygen anesthesia
• Broad spectrum of clinical usefulness
• But the incidence of cardiac arrythmias as
reported by Forbes, is enhanced with
halothane therefore this technique is some
what limited in ambulatory dentistry
86. Local anesthesia
• LA and nitrous oxide oxygen will give a state of
well being to the patient when the local in
fully effective
• The patient may not perceive painful stimuli
• The patient must be cooperative and must
realize
87. Nitrous oxide and its actions,
properties and effect on various
system
• The mechanism by which nitrous oxide exerts
its effect is current unknown
• In concentration of 10%-25% N2O most
frequently produces sensation of tingling and
numbness
• As the concentration of nitrous oxide reaches
25%-50% maximum analgesic properties are
realized and there are aberration of vision,
hearing and proprioception, mild drowsiness,
euphoria, amnesia and increased sleepiness
88. • Its effects of various systems:
1. CNS
2. Respiratory system
3. CVS
4. Fetal system
5. Other system
89. 1. CNS: the CNS specifically the cerebrum is the
system primarily affected by nitrous oxide
2. Respiratory system: the respiratory system is
slightly stimulated by 50%
• While no definite depression of respiration
occurs
• The dentist should be aware that the
respiratory depression associated with
administration of meperidine or thiopental is
deepened by concomitant use of nitrous
90. • CVS: the effects of nitrous oxide alone on the
CVS are generally considered to be significant
• Eisele and smith have evaluated the effect of
nitrous oxide oxygen on ten young adults.
They reported the heart rate decreased by as
much as 10% and cardiac output by much as
19% when subjects inhaled 40% nitrous oxide
as opposed to 40% nitrogen
• Evertl and Allen also conducted the same
study and obtained cardiac output and stroke
91. • Fetal system: Bussard has reviewed both the
literature on the teratogenic effects of nitrous
oxide on pregnanent animals the
epidemiologic evidence indicating that nitrous
oxide and epidemiological evidence indicating
that nitrous oxide may be a cause of
miscarriage in humans
• Cohen and co-workers reported that in a
survey of operating room frequently exposed
gases 29.7% of pregnancies endended in
92. • Other systems: The peripheral nervous system
and receptor sites don’t seem to be depressed
by nitrous oxide
• Depression of some spinal refluxes has been
demonstrated
• Neuromuscular system is not depressed by
nitrous oxide
• The major effect of nitrous oxide on the
gastrointestinal system is nausea and vomiting
• Hematopoietic is affects by prolongs exposure
93. Hypoxia associated with nitrous oxide
• Hypoxia may develop from the following
problems:
1. The anesthetic machine flow meters may be
subject to error, especially at low flow rates
2. Mccarthy, studying both flow meters and
pressure machines suggested that error in high
pressure delivery system is subjected to greater
error in oxygen delivery
3. Hyperventilation may be present during and
after nitrous oxide anesthesia
94. Complications associated with nitrous
oxide anesthesia
1. Hypoxia
2. Airway obstruct
3. Hypotension
4. Reflux stimuli
• Airway obstruction: misplaced oropharngeal
pack, cancer, enlarged tonsils, blood, dental
debris and foreign materials
• Hypotension: Bourse stated main danger in,
95. • Reflex stimuli: the reflex stimuli are initiated
from the throat pack, the dental prop and the
extraction of a tooth
• Frumin and rackow
96. Toxicity associated with nitrous oxide
• Bjorniboe
• In 1956 Lassen reported the recognition and
the role of nitrous oxide in producing
granulocytopenia and bone marrow
depression
• Lassen showed that hematologic complication
appeared 3 or 4 days after nitrous oxide
inhalation
• The administration of 50% nitrous oxide
oxygen resulted in the white cell count
97. Routes of administration for conscious
sedation
1. Oral
2. Inhalation
3. Intramuscular
4. Intravenous
5. Sublingual
6. Rectal
7. Intranasal or submucosa;
98. • ORAL: after swallowing a drug, absorption
occur primarily in the stomach and small
intestine and not from other parts of GIT.
• Drugs taken orally are exposed to the
potential of inactivation in either the stomach
or the liver