Document Text Contents
Page 1
11830 Westline Industrial Drive
St. Louis, Missouri 63146
SEDATION: A CLINICAL GUIDE TO PATIENT MANAGEMENT ISBN: 978-0-323-05680-9
Copyright © 2010, 2003, 1995, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s
Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333;
e-mail: [email protected] You may also complete your request on-line via the Elsevier website
at http://www.elsevier.com/permissions.
Library of Congress Cataloging-in-Publication Data or Control Number
Malamed, Stanley F., 1944-
Sedation : a guide to patient management / Stanley F. Malamed.—5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-05680-9 (pbk. : alk. paper) 1. Sedatives. 2. Anesthesia in dentistry. I. Title.
[DNLM: 1. Anesthesia, Dental—methods. 2. Conscious Sedation. 3. Deep Sedation. 4. Dental
Anxiety—prevention & control. 5. Pain—prevention & control. WO 460 M236s 2010]
RK512.S44M35 2010
615′.782—dc22
2009001828
Vice President and Publishing Director: Linda Duncan
Executive Editor: John Dolan
Developmental Editor: Brian S. Loehr
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Rachel E. McMullen
Design Direction: Jessica Williams
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is the responsibility of
the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to
determine dosages and the best treatment for each individual patient, and to take all appropriate safety
precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for
any injury and/or damage to persons or property arising out of or related to any use of the material
contained in this book.
The Publisher
Working together to grow
libraries in developing countries
www.elsevier.com | www.bookaid.org | www.sabre.org
Page 2
Chapter 1 Emergency Preparation and Management �
�
To Francis Foldes, MD, for having instilled in me an everlasting fascination in the art
and science of anesthesiology, and to Norman Trieger, DMD, MD and Thomas
Pallasch, DDS, MS, for having made possible a career that has provided me with
continued challenge, interest, and enjoyment, one that I would change for no other, and
to Horace Wells, DDS, who 165 years ago discovered anesthesia.
Dedication
Horace Wells (1815-1848) (Courtesy the
Horace Wells Museum, Hartford, Conn.)
Page 309
CHAPTER 23 Anatomy for Venipuncture 299
simplify the problem of restraint of the infant. In seriously ill
newborn infants, the umbilical vein may be used during the
first 24 to 48 hours of life.
Smaller children, because their limbs are “pudgier,” may
have superficial veins of the upper limb that are quite difficult
to visualize. The foot may prove a more acceptable site for
venipuncture.
In very obese adult patients, veins may prove difficult or
impossible to locate. A careful search of both arms and if
necessary the feet will usually be fruitful in locating one or
more veins. If the planned dental procedure is elective, the
absence of superficial veins should be considered a contrain-
dication to the use of IV sedation. Should it be essential to
establish an IV line, hospitalization of the patient, with sub-
sequent surgical cutdown to cannulate a vein, may be the
most prudent course of action.
Type of Intravenous Procedure
The chemical nature of the drugs administered, the size of the
vein to be cannulated, and the size of the needle are important
because they all may produce irritation of the inner wall of
the vein, a situation leading to an increased risk of
phlebitis.
In general, the larger the vein is in relation to the size of
the needle or catheter, the less likelihood there is that irrita-
tion and phlebitis will develop. This is because the drugs and
infusion solution will undergo more rapid dilution in the
blood where the caliber of the vein exceeds the outside diam-
eter of the needle or cannula. Mechanical irritation by the
needle or cannula against the endothelial wall of the vein is
another cause of phlebitis. Cannulation of larger veins is a
means of decreasing risk of venous irritation and subsequent
phlebitis.
Two drugs discussed in this section are capable of produc-
ing significant venous irritation. These drugs, diazepam (fre-
quently used) and pentobarbital (rarely used), are used
intravenously as sedatives in dentistry and medicine. Methods
of minimizing the risk of phlebitis when these drugs are
administered are discussed in Chapter 26. These drugs should
be administered slowly into a rapidly running IV infusion. In
addition, the use of larger veins will minimize but not elimi-
nate the risk of developing venous irritation.
RECOMMENDED SITES
FOR VENIPUNCTURE
Five potential sites for venipuncture in the upper limb have
been reviewed in this chapter. They are, in my order of prefer-
ence (Figure 23-7), as follows:
1. Dorsum of hand
2. Ventral forearm
3. Lateral antecubital fossa
4. Dorsal wrist
5. Medial antecubital fossa
The dorsum of the hand remains the most preferred site
because its veins are superficial and because of the anatomic
safety of the site. However, the dorsum is not always an
appropriate site for drugs that may produce venous irritation
(e.g., diazepam). A close second on my list is the ventral
forearm. This site is preferred for longer-duration procedures
and when the dorsum of the hand is not available. The
absence of a need for immobilization of a joint, anatomic
safety, and larger veins make this site suitable for most veni-
puncture procedures. A third preferred site, the lateral
antecubital fossa, is chosen for its larger veins and anatomic
safety.
Figure 23-7 Sites of venipuncture in order of preference: 1, dorsum of
hand; 2, ventral forearm; 3, lateral antecubital fossa; 4, dorsal wrist; and
5, medial antecubital fossa. (Adapted from Abbott Laboratories: Venipunc-
ture and venous circulation, Chicago, 1971, Abbott Laboratories.)
1
4
5
3
2
Page 310
300 CHAPTER 23 Anatomy for Venipuncture
Figure 23-8 Blood circulation in the upper extremity. Blood leaves the left ventricle; traverses arteries, arterioles, capillaries, venules, and veins and returns
to the right atrium via the superior vena cava.
Left ventricle
Ascending aorta
Aortic arch
Subclavian (brachiocephalic
[innominate] on right)
Brachial
Superficial and deep
volar arches
Axillary
RadialUlnar
Digital arteries
Capillaries
Arterioles
ARTERIAL SUPPLY
Capillaries
Venules
Dorsal venous network
Axillary
Median
Brachial
Axillary
Subclavian
Brachiocephalic
(innominate)
Superior vena cava
Right atrium of heart
Superficial and deep volar arches
Brachial
RadialUlnar
BasilicCephalic
Median basilicMedian cephalic
Deep veinsSuperficial veins
VENOUS RETURN
Page 617
Index 607
Tingling, during sedation, 236–237
Tinnitus, 32
Titration
definition of, 17
drug administration, method of, 17t
in geriatric patient, 518
importance of, 228
of orally administered drugs, 16–17
for subsequent sedation appointments,
260–261
Titration by appointment, 498–499
Tobacco
current use of, 45
Tonic-clonic seizure, generalized, 531
epilepsy and, 486
management of, 487b
Tonsillar suction tip, 418–419
Tonsils, inhalation sedation and, 251
Tooth pain, 251
Topical anesthesia, 11, 18
Topical application of drug, 18
Tort law, 561–562
Total intravenous anesthesia (TIVA)
equipment for, 413
inhalation sedation unit for, 414
Tourniquet, 289, 289f
application of, 306f
forgotten, 378
Toxic reaction, 455
Trace nitrous oxide
air sweeps and, 254
monitoring of, 254–257
Trachea, 197f
respiratory system, role in, 198
Tracheal intubation
dysrhythmia and, 479
Tracking, of vein, 331, 331f
Traditional nasal hood, 218f
Tranquilizer, major, 113
Transdermal drug administration, 18
advantages of, 126–127
Transdermal sedation
indication and types of, 126–127
Transdermal therapeutic system (TTS),
126
advantages of, 126
phamacokinetics of, 127
Transfusion, blood, 44
Transient ischemic attack (TIA), 549–550
Translocation DS, 554
Traumatic procedure
anesthesia as, 10
general anesthesia for, 408
Trendelenburg position, 484
Triazolam
dental drug interactions with, 38t–43t
oral administration of, 107–108
overview of, 108b
Tricyclic antidepressant
dental drug interactions with, 38t–43t
intravenous sedation and, 277
Trieger test, 228–229, 241f, 305
Trimethoprim
dental drug interactions with, 38t–43t
Trisomy 21, 554
Tuberculosis, 35
Tubocurarine, 425
Tumor, 36
Twilight sleep, 10
Type 1, insulin-dependent diabetes mellitus
(IDDM), 488, 539–540
Type 2, non-insulin-dependent diabetes
mellitus (NIDDM), 488, 539–540
U
Ulcer, 35
Ulnar artery, 293
Ultralight general anesthesia, 168, 403,
408–409
Unconscious patient
BIS values in, 76
management of, 21
from overdose, 459, 459f
Uncooperativeness, oversedation and, 247
Uncoordination, oversedation and, 247
Uneasiness, in patient, 4
Unknown, fear of, 4
Unstable angina, 521–522
as ASA 4 patient, 521–522
mortality rate of, 521
oral sedation and, 522
pain in, 521
See also Angina pectoris
Upper respiratory infection
inhalation sedation and, 185
Urinary problems, 32
Urinary tract
anticholinergic effect on, 155
Urine output, collection and measurement of,
421
Urticaria, 467
V
Vagal response
dysrhythmia and, 479
Valium, 103, 322
Valproic acid
dental drug interactions with, 38t–43t
epilepsy and, 532t
Valvular heart disease, 527
Van Horn v. Watson, 566–567
Vaporizer, 413
Vaporole, 449–450, 450f
Vascular system
diabetes mellitus and, 540t
Vasoconstrictor
contraindications for, 525b
dental drug interactions with, 38t–43t
in geriatric patient, 517
Vasodepressor
hypotension and, 475
Vasodepressor syncope, 471
Vasodilation
methods of, 306
nitrous oxide-oxygen as, 306
Vasodilator, 290f
for emergency kit, 446, 452
Vasopressor
cerebrovascular accident and, 533
heart failure and, 526
hyperthyroidism and, 536–537
indication for, 449
receptor, action on, 476t
valvular replacement and, 527
Vasopressor syncope. See Syncope
Vastus lateralis, for IM drug administration,
135–136, 135f–136f
Vecuronium, 425
Vein
distention of, 306f
tracking of, 331, 331f
of upper limb, 294
Vein locating device, 307f
Venereal disease, 36
Venipuncture
blood return, 312, 312f
complications from, 384–386
air embolism, 381
cause of, 381
drug related, 377b, 386–392
IV infusion bag level, 376–377
needle placement, 378f
nonrunning IV infusion, 376–381
overhydration, 381
prevention of, 385
tourniquet and, 378f
with continuous infusion, 281, 281f
equipment for, 280, 414
equipment preparation for, 302–304, 303f
in geriatric patient, 517–518
hematoma from, 379–380
infiltration and, 378–379
nitrous oxide-oxygen as aid for, 306
patient cooperation for, 20, 275
patient preparation for, 304–308
proficiency in, 396
qualification for administering, 395
recognition and management of, 385–386
site selection for, 299f
comparison of, 301t
factors involving, 298–299
technique for
antecubital fossa, 313–314
hand, dorsum of, 311–312
ventral forearm, 313, 314f
wrist, dorsum of, 312, 313f
terminating infusion, 315, 315f
tourniquet application for, 306f
upper limb
arteries of, 292–294
veins of, 294
venous distention for, 306, 306f
without continuous infusion, 280, 281f
See also Intravenous drug administration
See also Venospasm
Venospasm
indication of, 379
recognition and management of, 379
Ventilation
assisted/controlled, 389f
controlled, 446–447
monitoring guidelines for, 65b–66b
sedation and, 11
Ventral forearm. See Forearm
Ventricular defibrillation, 51
Ventricular septal defect, 526
Ventrogluteal region, for IM drug
administration, 135, 135f
Verrill, P.J., 273
Verrill sign, 273, 317, 318f
Vertigo, 251
Viral hepatitis, 534
Viral infection, 31
Virus
multiple sclerosis and, 547
Vision, blurred, 32
Visual inspection, of patient, 53–54
Vital signs
on anesthesia record, 429f
baseline, 67f
difficulties in monitoring, 78–79
during IV sedation, 355–356
monitor for, 70f, 75f
monitoring guidelines for
adults, 68t
children, 69t
in pediatric patient, 500
preoperative and postoperative, 60
preoperative chart for, 359f
Venipuncture (Continued)
Page 618
608 Index
sedation and, 50, 64
types of, 47–53
Vocal cord
laryngospasm and, 391
view of, 391f
Vomiting, 31
under anesthesia
incidence of, 484
management of, 484
pediatric patient and, 507–508
cause of, 386–387
from inhalation sedation, 249–251
management of, 250–251, 250f, 387
opioid agonist and morphine, effect on, 147
signs and symptoms of, 250
Von Liebig, 166
von Mering, J., 272
Vulnerability
death, fear of, 4–5
patient position and, 4
W
Waiting time, minimization of, 60
Waiver, to consent, 563
Waldie, David, 171
Walters, John, 561
Warmth, during sedation, 228–229
Washington, James Augustus, 272
Water vapor
composition of, 200
Weight
guidelines for, 53, 53f
technique for, 53
Weight loss, 31
Wells, Dr. Horace, 166–167, 168f, 170f, 265,
573–574, 573f
Wheals, 467
Wheezing, 72–73, 73t
airway obstruction and, 481
as allergic reaction, 467
management of, 481t
partial airway obstruction and, 483
Whipped cream, 257–258, 257f
Whippet, 257–258
White-knuckle syndrome, 228–229, 238f
Whooshing, 72
management of, 481t
Winged infusion set, 310
Winged needle, 286, 287f, 310f
Woo v. Foreman’s Fund Insurance Co., 560
Wren, Sir Christopher, 272
Wright’s classification, 497
Wrist
dorsum of, 295–296, 295f, 312, 313f
Writ of certiorari, 580f
Wyckoff, B.S., 272–273
Y
Yellow fever board, 563
Yoke, 212–213
Young’s rule
for IM drug administration, 140
for pediatric drug dosages, 499
Z
Zaleplon (Sonata)
dental drug interactions with, 38t–43t
oral administration of, 109–111
overview of, 110b
Zerfas, L.G., 272
Zolpidem (Ambien)
dental drug interactions with, 38t–43t
oral administration of, 109–110
overview of, 110b
Vital signs (Continued)
11830 Westline Industrial Drive
St. Louis, Missouri 63146
SEDATION: A CLINICAL GUIDE TO PATIENT MANAGEMENT ISBN: 978-0-323-05680-9
Copyright © 2010, 2003, 1995, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s
Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333;
e-mail: [email protected] You may also complete your request on-line via the Elsevier website
at http://www.elsevier.com/permissions.
Library of Congress Cataloging-in-Publication Data or Control Number
Malamed, Stanley F., 1944-
Sedation : a guide to patient management / Stanley F. Malamed.—5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-05680-9 (pbk. : alk. paper) 1. Sedatives. 2. Anesthesia in dentistry. I. Title.
[DNLM: 1. Anesthesia, Dental—methods. 2. Conscious Sedation. 3. Deep Sedation. 4. Dental
Anxiety—prevention & control. 5. Pain—prevention & control. WO 460 M236s 2010]
RK512.S44M35 2010
615′.782—dc22
2009001828
Vice President and Publishing Director: Linda Duncan
Executive Editor: John Dolan
Developmental Editor: Brian S. Loehr
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Rachel E. McMullen
Design Direction: Jessica Williams
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is the responsibility of
the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to
determine dosages and the best treatment for each individual patient, and to take all appropriate safety
precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for
any injury and/or damage to persons or property arising out of or related to any use of the material
contained in this book.
The Publisher
Working together to grow
libraries in developing countries
www.elsevier.com | www.bookaid.org | www.sabre.org
Page 2
Chapter 1 Emergency Preparation and Management �
�
To Francis Foldes, MD, for having instilled in me an everlasting fascination in the art
and science of anesthesiology, and to Norman Trieger, DMD, MD and Thomas
Pallasch, DDS, MS, for having made possible a career that has provided me with
continued challenge, interest, and enjoyment, one that I would change for no other, and
to Horace Wells, DDS, who 165 years ago discovered anesthesia.
Dedication
Horace Wells (1815-1848) (Courtesy the
Horace Wells Museum, Hartford, Conn.)
Page 309
CHAPTER 23 Anatomy for Venipuncture 299
simplify the problem of restraint of the infant. In seriously ill
newborn infants, the umbilical vein may be used during the
first 24 to 48 hours of life.
Smaller children, because their limbs are “pudgier,” may
have superficial veins of the upper limb that are quite difficult
to visualize. The foot may prove a more acceptable site for
venipuncture.
In very obese adult patients, veins may prove difficult or
impossible to locate. A careful search of both arms and if
necessary the feet will usually be fruitful in locating one or
more veins. If the planned dental procedure is elective, the
absence of superficial veins should be considered a contrain-
dication to the use of IV sedation. Should it be essential to
establish an IV line, hospitalization of the patient, with sub-
sequent surgical cutdown to cannulate a vein, may be the
most prudent course of action.
Type of Intravenous Procedure
The chemical nature of the drugs administered, the size of the
vein to be cannulated, and the size of the needle are important
because they all may produce irritation of the inner wall of
the vein, a situation leading to an increased risk of
phlebitis.
In general, the larger the vein is in relation to the size of
the needle or catheter, the less likelihood there is that irrita-
tion and phlebitis will develop. This is because the drugs and
infusion solution will undergo more rapid dilution in the
blood where the caliber of the vein exceeds the outside diam-
eter of the needle or cannula. Mechanical irritation by the
needle or cannula against the endothelial wall of the vein is
another cause of phlebitis. Cannulation of larger veins is a
means of decreasing risk of venous irritation and subsequent
phlebitis.
Two drugs discussed in this section are capable of produc-
ing significant venous irritation. These drugs, diazepam (fre-
quently used) and pentobarbital (rarely used), are used
intravenously as sedatives in dentistry and medicine. Methods
of minimizing the risk of phlebitis when these drugs are
administered are discussed in Chapter 26. These drugs should
be administered slowly into a rapidly running IV infusion. In
addition, the use of larger veins will minimize but not elimi-
nate the risk of developing venous irritation.
RECOMMENDED SITES
FOR VENIPUNCTURE
Five potential sites for venipuncture in the upper limb have
been reviewed in this chapter. They are, in my order of prefer-
ence (Figure 23-7), as follows:
1. Dorsum of hand
2. Ventral forearm
3. Lateral antecubital fossa
4. Dorsal wrist
5. Medial antecubital fossa
The dorsum of the hand remains the most preferred site
because its veins are superficial and because of the anatomic
safety of the site. However, the dorsum is not always an
appropriate site for drugs that may produce venous irritation
(e.g., diazepam). A close second on my list is the ventral
forearm. This site is preferred for longer-duration procedures
and when the dorsum of the hand is not available. The
absence of a need for immobilization of a joint, anatomic
safety, and larger veins make this site suitable for most veni-
puncture procedures. A third preferred site, the lateral
antecubital fossa, is chosen for its larger veins and anatomic
safety.
Figure 23-7 Sites of venipuncture in order of preference: 1, dorsum of
hand; 2, ventral forearm; 3, lateral antecubital fossa; 4, dorsal wrist; and
5, medial antecubital fossa. (Adapted from Abbott Laboratories: Venipunc-
ture and venous circulation, Chicago, 1971, Abbott Laboratories.)
1
4
5
3
2
Page 310
300 CHAPTER 23 Anatomy for Venipuncture
Figure 23-8 Blood circulation in the upper extremity. Blood leaves the left ventricle; traverses arteries, arterioles, capillaries, venules, and veins and returns
to the right atrium via the superior vena cava.
Left ventricle
Ascending aorta
Aortic arch
Subclavian (brachiocephalic
[innominate] on right)
Brachial
Superficial and deep
volar arches
Axillary
RadialUlnar
Digital arteries
Capillaries
Arterioles
ARTERIAL SUPPLY
Capillaries
Venules
Dorsal venous network
Axillary
Median
Brachial
Axillary
Subclavian
Brachiocephalic
(innominate)
Superior vena cava
Right atrium of heart
Superficial and deep volar arches
Brachial
RadialUlnar
BasilicCephalic
Median basilicMedian cephalic
Deep veinsSuperficial veins
VENOUS RETURN
Page 617
Index 607
Tingling, during sedation, 236–237
Tinnitus, 32
Titration
definition of, 17
drug administration, method of, 17t
in geriatric patient, 518
importance of, 228
of orally administered drugs, 16–17
for subsequent sedation appointments,
260–261
Titration by appointment, 498–499
Tobacco
current use of, 45
Tonic-clonic seizure, generalized, 531
epilepsy and, 486
management of, 487b
Tonsillar suction tip, 418–419
Tonsils, inhalation sedation and, 251
Tooth pain, 251
Topical anesthesia, 11, 18
Topical application of drug, 18
Tort law, 561–562
Total intravenous anesthesia (TIVA)
equipment for, 413
inhalation sedation unit for, 414
Tourniquet, 289, 289f
application of, 306f
forgotten, 378
Toxic reaction, 455
Trace nitrous oxide
air sweeps and, 254
monitoring of, 254–257
Trachea, 197f
respiratory system, role in, 198
Tracheal intubation
dysrhythmia and, 479
Tracking, of vein, 331, 331f
Traditional nasal hood, 218f
Tranquilizer, major, 113
Transdermal drug administration, 18
advantages of, 126–127
Transdermal sedation
indication and types of, 126–127
Transdermal therapeutic system (TTS),
126
advantages of, 126
phamacokinetics of, 127
Transfusion, blood, 44
Transient ischemic attack (TIA), 549–550
Translocation DS, 554
Traumatic procedure
anesthesia as, 10
general anesthesia for, 408
Trendelenburg position, 484
Triazolam
dental drug interactions with, 38t–43t
oral administration of, 107–108
overview of, 108b
Tricyclic antidepressant
dental drug interactions with, 38t–43t
intravenous sedation and, 277
Trieger test, 228–229, 241f, 305
Trimethoprim
dental drug interactions with, 38t–43t
Trisomy 21, 554
Tuberculosis, 35
Tubocurarine, 425
Tumor, 36
Twilight sleep, 10
Type 1, insulin-dependent diabetes mellitus
(IDDM), 488, 539–540
Type 2, non-insulin-dependent diabetes
mellitus (NIDDM), 488, 539–540
U
Ulcer, 35
Ulnar artery, 293
Ultralight general anesthesia, 168, 403,
408–409
Unconscious patient
BIS values in, 76
management of, 21
from overdose, 459, 459f
Uncooperativeness, oversedation and, 247
Uncoordination, oversedation and, 247
Uneasiness, in patient, 4
Unknown, fear of, 4
Unstable angina, 521–522
as ASA 4 patient, 521–522
mortality rate of, 521
oral sedation and, 522
pain in, 521
See also Angina pectoris
Upper respiratory infection
inhalation sedation and, 185
Urinary problems, 32
Urinary tract
anticholinergic effect on, 155
Urine output, collection and measurement of,
421
Urticaria, 467
V
Vagal response
dysrhythmia and, 479
Valium, 103, 322
Valproic acid
dental drug interactions with, 38t–43t
epilepsy and, 532t
Valvular heart disease, 527
Van Horn v. Watson, 566–567
Vaporizer, 413
Vaporole, 449–450, 450f
Vascular system
diabetes mellitus and, 540t
Vasoconstrictor
contraindications for, 525b
dental drug interactions with, 38t–43t
in geriatric patient, 517
Vasodepressor
hypotension and, 475
Vasodepressor syncope, 471
Vasodilation
methods of, 306
nitrous oxide-oxygen as, 306
Vasodilator, 290f
for emergency kit, 446, 452
Vasopressor
cerebrovascular accident and, 533
heart failure and, 526
hyperthyroidism and, 536–537
indication for, 449
receptor, action on, 476t
valvular replacement and, 527
Vasopressor syncope. See Syncope
Vastus lateralis, for IM drug administration,
135–136, 135f–136f
Vecuronium, 425
Vein
distention of, 306f
tracking of, 331, 331f
of upper limb, 294
Vein locating device, 307f
Venereal disease, 36
Venipuncture
blood return, 312, 312f
complications from, 384–386
air embolism, 381
cause of, 381
drug related, 377b, 386–392
IV infusion bag level, 376–377
needle placement, 378f
nonrunning IV infusion, 376–381
overhydration, 381
prevention of, 385
tourniquet and, 378f
with continuous infusion, 281, 281f
equipment for, 280, 414
equipment preparation for, 302–304, 303f
in geriatric patient, 517–518
hematoma from, 379–380
infiltration and, 378–379
nitrous oxide-oxygen as aid for, 306
patient cooperation for, 20, 275
patient preparation for, 304–308
proficiency in, 396
qualification for administering, 395
recognition and management of, 385–386
site selection for, 299f
comparison of, 301t
factors involving, 298–299
technique for
antecubital fossa, 313–314
hand, dorsum of, 311–312
ventral forearm, 313, 314f
wrist, dorsum of, 312, 313f
terminating infusion, 315, 315f
tourniquet application for, 306f
upper limb
arteries of, 292–294
veins of, 294
venous distention for, 306, 306f
without continuous infusion, 280, 281f
See also Intravenous drug administration
See also Venospasm
Venospasm
indication of, 379
recognition and management of, 379
Ventilation
assisted/controlled, 389f
controlled, 446–447
monitoring guidelines for, 65b–66b
sedation and, 11
Ventral forearm. See Forearm
Ventricular defibrillation, 51
Ventricular septal defect, 526
Ventrogluteal region, for IM drug
administration, 135, 135f
Verrill, P.J., 273
Verrill sign, 273, 317, 318f
Vertigo, 251
Viral hepatitis, 534
Viral infection, 31
Virus
multiple sclerosis and, 547
Vision, blurred, 32
Visual inspection, of patient, 53–54
Vital signs
on anesthesia record, 429f
baseline, 67f
difficulties in monitoring, 78–79
during IV sedation, 355–356
monitor for, 70f, 75f
monitoring guidelines for
adults, 68t
children, 69t
in pediatric patient, 500
preoperative and postoperative, 60
preoperative chart for, 359f
Venipuncture (Continued)
Page 618
608 Index
sedation and, 50, 64
types of, 47–53
Vocal cord
laryngospasm and, 391
view of, 391f
Vomiting, 31
under anesthesia
incidence of, 484
management of, 484
pediatric patient and, 507–508
cause of, 386–387
from inhalation sedation, 249–251
management of, 250–251, 250f, 387
opioid agonist and morphine, effect on, 147
signs and symptoms of, 250
Von Liebig, 166
von Mering, J., 272
Vulnerability
death, fear of, 4–5
patient position and, 4
W
Waiting time, minimization of, 60
Waiver, to consent, 563
Waldie, David, 171
Walters, John, 561
Warmth, during sedation, 228–229
Washington, James Augustus, 272
Water vapor
composition of, 200
Weight
guidelines for, 53, 53f
technique for, 53
Weight loss, 31
Wells, Dr. Horace, 166–167, 168f, 170f, 265,
573–574, 573f
Wheals, 467
Wheezing, 72–73, 73t
airway obstruction and, 481
as allergic reaction, 467
management of, 481t
partial airway obstruction and, 483
Whipped cream, 257–258, 257f
Whippet, 257–258
White-knuckle syndrome, 228–229, 238f
Whooshing, 72
management of, 481t
Winged infusion set, 310
Winged needle, 286, 287f, 310f
Woo v. Foreman’s Fund Insurance Co., 560
Wren, Sir Christopher, 272
Wright’s classification, 497
Wrist
dorsum of, 295–296, 295f, 312, 313f
Writ of certiorari, 580f
Wyckoff, B.S., 272–273
Y
Yellow fever board, 563
Yoke, 212–213
Young’s rule
for IM drug administration, 140
for pediatric drug dosages, 499
Z
Zaleplon (Sonata)
dental drug interactions with, 38t–43t
oral administration of, 109–111
overview of, 110b
Zerfas, L.G., 272
Zolpidem (Ambien)
dental drug interactions with, 38t–43t
oral administration of, 109–110
overview of, 110b
Vital signs (Continued)
