This document discusses pharmacological methods of behavioral management, including intramuscular, intravenous, and reversal agents. It describes ketamine and midazolam as intramuscular drugs that provide sedation and analgesia. Propofol and midazolam are discussed as intravenous options, with propofol noted for its fast onset but risk of respiratory depression. Flumazenil and naloxone are mentioned as reversal agents for benzodiazepines and opioids respectively. Preanesthetic medication is defined as drugs used before anesthesia to reduce anxiety and facilitate smooth induction. Pethidine, atropine, diazepam, and lorazepam are listed as common preanesthetic options.

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