Concious-Sedation-Pedo.ppt

7/23/2019 Concious-Sedation-Pedo.ppt

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CONSCIOUS

SEDATION


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DEFINITION:

A minimally depressed levelof consciousness that retains

the patients ability to maintainairway independently andrespond appropriately to

physical stimulation and verbalcommand.


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Moderate Sedation: A depressed level of

consciousness that carries the risk of losingprotective reflexes.

Sedation Criteria Includes:

ability to retain protective airway reflexes

ability to independently and continuously

maintain a patent airway

ability to respond appropriately to both

physical and verbal stimuli


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OBJECTIVES The patients mood should be altered. Patient should be conscious, respond to

verbal stimuli.

Patient should be co-operative. All protective reflexes should be intact. Vital signs stable and normal.

Childs pain threshold should beincreased.

Amnesia should occur.


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INDICATIONS:

Patients who cannot cooperate orunderstand for definitive treatment.

Patient lacing cooperation because of

lac of ps!chological or emotionalmaturit!. Patients with dental care re"uirements

but are fear full and anxious.

#f long procedures are advocated for anervous and apprehensive child.


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$outes of Administration

INHALATIONAL (N2O

!NT!"AL ( O"AL O" "!#TAL

$A"!NT!"AL -Intramuscular

- Subcutaneous

- Intranasal

- Submucosal

- Intravenous


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American Society of

Anesthesiology / ASA

ClassificationA.S.A. Class 1: No organic, physiologic, biochemical, or psychiatric

disturbance. The pathologic process for which the operation is to be performed is

localized and does not entail a systemic disturbance.

A.S.A. Class 2: Mild to moderate systemic disease disturbance causeeither by the condition to be treated surgically or by other pathologicprocesses:

well-controlled hypertension; and no postural hypertension history of asthma, no wheezing on day of procedure

anemia; Hct greater or equal to 3 gm cigarette use; without !"#$ problems well-controlled diabetes mellitus; mild obesity; %& abo'e ideal body weight ()*+ age year or /0 years; and pregnancy.


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ASA Level Cont.

A.S.A Class : Se!ere systemic disturbance of disease from "hate!er cause,e!en though it may not be possible to define the degree of disability "ithfinality:

angina;

status post-myocardial infarction; less than 3 months ago poorly controlled hypertension; symptomatic respiratory disease (e.g., asthma, !"#$; and massi'e obesity, greater than 1 pounds or 3& of )*+

A.S.A. Class #: $ndicati!e of the patient "ith se!ere systemic disorders that arealready life threatening, not al"ays correctable by operation:

unstable angina, unrelie'ed by 2itroglycerin and rest congesti'e heart failure; debilitating respiratory disease; and hepatorenal failure.


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allampati System

!he Mallampati system anticipates the

degree of difficulty of endotracheal

intubation from I to IV,by relatingtongue si"e to pharyngeal si"e. #atient is

examined in the sitting position$ with head

in neutral position and mouth open %&'(&mm )*'*+,* inches- and the tongue

protruding to the maximum.


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allampati System Cont.


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Characteristics of #otential

ifficult Airway!he following physical characteristics may indicate the

potential for difficult airway management:

/yponathic 0aw )recessed-

/ypernathic 0aw )protruding-

eviated trachea

Large tongue

Short thick neck

#rotruding teeth

/igh arched palate


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#atient Classification Scheme

Class I Anormal$ healthy patient with a locali"edpathological process.

Class IIA patient with well'controlled systemic

disease which does not limit activity. Class III A patient with moderate'severe systemicdisease that limits daily activity.

Class IV A patient with severe disease that is a daily

threat to life. Class VA patient at substantial risk of death within *1

hours.

E2mergency status3 added to patient class if

individual is undergoing an emergency procedure.


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24uipment 5eeds

%mergency e&uipment, including a defibrillator, must beimmediately accessible to e!ery location "hereconscious sedation is administered. 'he e&uipment

should include, but not be limited to the follo"ing: emergency, resuscitation, and antagonist drugs; airway and 'entilator adunct equipment for adult and

pediatric patients; defibrillator;

source for administration of & o4ygen and capability for suctioning of the patient.


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. Oral RouteA%VA&TA'()*

Convenience

(conom!+ac of toxicit!.

ften Painless


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-

Route

Advanta%es&

aster absorption

Technical Advantages&'It reuires no special euipmentlittle or no patient cooperation is

reuiredfull calculated dose can be %iven witha hi%h de%ree of certainty.

% d


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%isadvantages: ,nset* Absorption of the in)ected

dru% can be decreased or delayed byseveral factors

.

A patient who is cold or ver! anxiousma! experience peripheral vasoconstriction in the area of the inection

significantl! decrease the rate ofabsorption.

/iggest variable in onset is related towhere the drug is actuall! deposited.


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s RouteA%VA&TA'()*- )ite*- *ore comfortable

and convenient for thedentist as well as thepatient


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+isadvanta%es& The rate of absorption is slower because

of lesser blood supply.

Tissue )lough& ,ecause the dru% isdeposited close to the surface of thes-in or mucosa tissue slou%hin% ispossible.

+iabilit! Costs*


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Intravenous

Route:A%VA&TA'()*-

Titration*'/mall increments of doses

may be %iven over a short period of timeuntil the desired effect is achieved

Test %ose*

#ntravenous Access*


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%#)A%VA&TA'()*-

#ntravenous Access isdifficult

Placement 0 maintenance of

#.V. Catheter is difficult.$e"uire both training 0

(xtensive Practice.


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Aents "n

Consc"ousSe#at"onSedative-hypnotics

Anti-an!iety agents

"arcotic analgesics


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&ameof drug 1ode ofaction (ffect )ideeffectsChlorh!

-drate

#nhibiting

the

reticular

activating

)!stem

0#ntroduce

sedation

0%ecrease

anxiet!

0#ncrease

painthreshold

'astric

irritabilit!

)(%AT#V( 0 23P&T#C)


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%rug1ode ofaction

(ffect

#ia$epam %ecreasethe activit!

of limbic

s!stem

%ecrease or

remove anxiet!

in patients with

mental

retardation

ida"olam %ecreasethe activit!

of limbic

s!stem

Anxiol!tic 0causes amnesia

Anti-anxiet! %rugs


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%rug

1ode of

action

(ffect )ide

effect

1orphine #ncreasepain

threshold

Causeanalgesi

a

$esp.%istre

ss

&arcotic Analgesics


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%issoctative anesthesia

where a cataleptic statecan be induced.

Potent analgesic

Potential for oral use

4(TA1#&(*- Causes*-

%eneral Anesthetics drugs used

in Conscious Sedation


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Chronic obstructive pulmonar!disorder, pregnanc!, m!asthenia,

epileps!, obesit!, bleeding disorders. 5ncooperative patients, unwilling,unaccompanied.

%ental difficulties prolonged surger!,

inade"uate personnel.

CONTRAINDICATI

ONS:


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