Table of Contents
001science
002science
Dedication
003science
004science
Preface
REFERENCE
005science
About This Book
006science
New to This Edition
007science
Acknowlegments
008science
Sedation in Dentistry A Historic Perspective
REFERENCES
009science
Pain and Anxiety in Dentistry
BASIC FEARS
DENTAL FEARS
REFERENCES
010science
SECTION II SPECTRUM OF PAIN AND ANXIETY CONTROL
REFERENCE
011science
Introduction to Sedation
DEFINITIONS
The Concept of “Rescue”
SUMMARY
REFERENCES
012science
The Spectrum of Pain and Anxiety Control
NO ANESTHESIA
IATROSEDATION
OTHER NONDRUG PSYCHOSEDATIVE TECHNIQUES
ROUTES OF DRUG ADMINISTRATION
Oral
Rectal
Topical
Sublingual
Intranasal
Transdermal
Subcutaneous
Intramuscular
Inhalation (Pulmonary)
Intravenous
GENERAL ANESTHESIA
REFERENCES
013science
Physical and Psychological Evaluation
GOALS OF PHYSICAL AND PSYCHOLOGICAL EVALUATION
PHYSICAL EVALUATION
Medical History Questionnaire
Physical Examination
Vital Signs
Visual Inspection of the Patient
Additional Evaluation Procedures
Dialogue History
RECOGNITION OF ANXIETY
DETERMINATION OF MEDICAL RISK
PHYSICAL STATUS CLASSIFICATION SYSTEM
ASA 1
ASA 2
ASA 3
ASA 4
ASA 5
STRESS-REDUCTION PROTOCOLS
Stress-Reduction Protocol: Normal, Healthy, but Anxious Patient (ASA 1)
Stress-Reduction Protocol: Medical Risk Patient (ASA 2, 3, and 4)
Recognition of Medical Risk and Anxiety
Medical Consultation
Premedication
Appointment Scheduling
Minimization of Waiting Time
Vital Signs (Preoperative and Postoperative)
Psychosedation During Therapy
Adequate Pain Control During Therapy
Duration of Treatment
Postoperative Control of Pain and Anxiety
Pain Control
REFERENCES
014science
Monitoring During Sedation
ROUTINE PREOPERATIVE MONITORING
Pulse (Heart Rate and Rhythm)
Blood Pressure
Electrocardiography
Respiration
Pulse Oximetry
Carbon Dioxide Monitoring
Bispectral Electroencephalographic Monitoring (BIS Monitoring)
Temperature
Other Monitoring Devices and Techniques
RECORDKEEPING
Sedation Record
General Anesthesia Record
REFERENCES
015science
Nondrug Techniques: Iatrosedation and Hypnosis
IATROSEDATION
Preparatory Communication
Euphemistic Language
Euphemistic Language in Sedation
Iatrosedation: Staff and Office
Clinical Demeanor
The Goal of Iatrosedation
HYPNOSIS
Hypnosis in Dentistry
The Success of Hypnosis
Education in Hypnosis
SUMMARY
REFERENCES
016science
SECTION III ORAL, RECTAL, AND INTRAMUSCULAR SEDATION
017science
Oral Sedation
ADVANTAGES
DISADVANTAGES
Absorption
Bioavailability
RATIONALE FOR USE
DRUGS
ANTIANXIETY DRUGS
Benzodiazepine Antianxiety Agents
Pharmacology
Chlordiazepoxide
Diazepam
Oxazepam
Clorazepate
Alprazolam
SEDATIVE-HYPNOTICS
Benzodiazepine Sedative-Hypnotics
Benzodiazepines
Flurazepam
Temazepam
Triazolam
Lorazepam
Midazolam
Nonbenzodiazepine Anxiolytics-Hypnotics
Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
Chloral Derivatives
Chloral Hydrate
HISTAMINE (H1) BLOCKERS (ANTIHISTAMINES)
Promethazine
Contraindications
Warnings
Precautions
Adverse Reactions
Dosage
Availability
Hydroxyzine
Contraindications
Drug Interactions
Precautions
Dosage
Availability
OPIOIDS (NARCOTICS)
THE ORAL SEDATION APPOINTMENT—Adult patient
SUMMARY
REFERENCES
018science
Rectal Sedation
ADVANTAGES
DISADVANTAGES
DRUGS
Hydromorphone
Dosage
Availability
Oxymorphone
Dosage
Availability
Promethazine
Dosage
Availability
Chloral Hydrate
Dosage
Availability
Diazepam
Midazolam
Availability
Ketamine
Lytic Cocktail
COMPLICATIONS OF RECTAL ADMINISTRATION
SUMMARY
REFERENCES
019science
Sublingual, Transdermal, and Intranasal Sedation
SUBLINGUAL SEDATION
Nitroglycerin
Opioids
Oral Transmucosal Fentanyl Citrate (Fentanyl “Lollipop”)
Sedatives
SUMMARY (sublingual sedation)
TRANSDERMAL SEDATION
Opioids
Antiemetics
SUMMARY (transdermal sedation)
INTRANASAL SEDATION
Midazolam
Sufentanil
SUMMARY (intranasal sedation)
REFERENCES
020science
Intramuscular Sedation
SUBMUCOSAL SEDATION
SITES OF INTRAMUSCULAR DRUG ADMINISTRATION
Gluteal Area
Ventrogluteal Region
Vastus Lateralis
Deltoid
Site Selection
ARMAMENTARIUM
TECHNIQUE
COMPLICATIONS
DETERMINATION OF DOSAGE
DRUGS
Antianxiety Drugs and Sedative-Hypnotics
Chlordiazepoxide
Diazepam
Lorazepam
Midazolam
Histamine Blockers (Antihistamines)
Promethazine
Hydroxyzine
Opioid Agonists
Pharmacology
Morphine
Meperidine
Meperidine With Promethazine
Fentanyl
Opioid Agonist-Antagonists
Pentazocine
Butorphanol
Nalbuphine
Nonsteroidal Antiinflammatory Drugs
Ketorolac
Dissociative Anesthetic
Ketamine
Anticholinergic Drugs
Pharmacology
Atropine
Scopolamine
Glycopyrrolate
Intramuscular Sedation Techniques
Commonly Used Intramuscular Drug Combinations
Midazolam or Diazepam and Opioid Agonist
Promethazine Plus Opioid
Hydroxyzine Plus Opioid
Meperidine, Promethazine, and Chlorpromazine
Monitoring During Intramuscular Sedation
The IM Sedation Appointment
SUMMARY
REFERENCES
021science
SECTION IV INHALATION SEDATION
ACKNOWLEDGMENTS
REFERENCES
022science
Inhalation Sedation: Historical Perspective
BEGINNINGS (PRE-1844)
THE EARLY DAYS (1844-1862)
ANESTHESIA DEVELOPS (1863-1898)
THE TWENTIETH CENTURY
MODERN TIMES (1950-PRESENT)
The Development of Courses and Guidelines
The Early Anesthesia Machine
REFERENCES
023science
Inhalation Sedation: Rationale
ADVANTAGES
Disadvantages
INDICATIONS
Anxiety
Medically Compromised Patients
Cardiovascular Disease
Respiratory Disease
Cerebrovascular Disease
Hepatic Disease
Epilepsy and Seizure Disorders
Pregnancy
Allergy
Diabetes
Gagging
CONTRAINDICATIONS
Patients With a Compulsive Personality
Claustrophobic Patients
Children With Severe Behavior Problems
Patients With Severe Personality Disorders
Upper Respiratory Tract Infection or Other Acute Respiratory Conditions
Chronic Obstructive Pulmonary Disease
The Patient Who Does Not Want N2O-O2
Pregnancy
RESTORATIVE DENTISTRY
Initial Dental Examination
Removal of Provisional Crowns or Bridges
Occlusal Adjustment
Insertion of Matrix Bands or Wedges
PERIODONTICS AND DENTAL HYGIENE
Initial Periodontal Examination
Scaling, Curettage, and Root Planing
Emergency Management of Necrotizing Ulcerative Gingivitis
Use of Ultrasonic Instruments
Periodontal Surgery
ORAL AND MAXILLOFACIAL SURGERY
Lengthy Surgical Procedures
Management of Abscesses
Management of Postoperative Complications
Suture Removal
ENDODONTICS
Rubber Dam Clamps
Gaining Access to the Pulp Chamber
Instrumenting Canals
Filling of Root Canals
FIXED PROSTHODONTICS
Impression Taking
Removal of Provisional Crowns and Bridges
Adjustment of Castings
REMOVABLE PROSTHODONTICS
Preparation of Abutment Teeth
Determination of Centric Relationships
Occlusal Adjustments and Impression Taking
Fitting of Immediate Dentures
ORAL RADIOLOGY
ORTHODONTICS
PEDIATRIC DENTISTRY
REFERENCES
024science
Pharmacology, Anatomy, and Physiology
NITROUS OXIDE
Preparation
Properties
Physical Properties
Chemical Properties
Solubility
Potency
Pharmacology
Central Nervous System
Cardiovascular System
Respiratory System
Gastrointestinal Tract
Kidneys
Hematopoiesis
Skeletal Muscle
Uterus and Pregnancy
Physiologic Contraindications
OXYGEN
Preparation
Properties
Effects of 100% Oxygen
Central Nervous System
Cardiovascular System
Respiratory System
RESPIRATORY SYSTEM
Nose
Mouth
Pharynx
Epiglottis
Larynx
Trachea
Bronchi
Bronchioles
Alveolus
RESPIRATION
Mechanics of Respiration
Composition of Respiratory Gases
REFERENCES
025science
Inhalation Sedation Equipment
TYPES OF INHALATION SEDATION UNITS
Demand-Flow Units
Continuous-Flow Units
Portable System
Central Storage System
Central Storage System With Mobile Heads
Compressed-Gas Cylinders
Oxygen Cylinder and Contents
Nitrous Oxide Cylinder and Contents
Regulators
Manifolds (Central System Only)
Yokes (Portable System Only)
Flowmeters
Flowmeter Advancements
Emergency Air Intake Valve
Latex-Free Accessory Equipment
Reservoir Bag
Conducting Tubes
Breathing Apparatus
SAFETY FEATURES
Pin Index Safety System
Diameter Index Safety System
Minimum Oxygen Liter Flow
Minimum Oxygen Percentage
Oxygen Fail Safe
Emergency Air Inlet
Alarm
Oxygen Flush Button
Reservoir Bag
Color Coding
Lock
Quick Connect for Positive-Pressure Oxygen
AVAILABLE INHALATION SEDATION UNITS
REFERENCES
026science
Inhalation Sedation: Techniques of Administration
GENERAL DESCRIPTION
ADMINISTRATION
Pretreatment Visit and Instructions
Day of Appointment
Monitoring During Inhalation Sedation
Preparation of the Equipment
Preparation of the Patient
Technique of Administration
Subsequent Appointments
COMPARISON OF TECHNIQUES OF ADMINISTRATION
Constant Liter Flow Technique
Summary of Technique
Advantages
Disadvantage
Examples of Technique
Constant O2 Flow Technique
Summary of Technique
Advantages
Disadvantages
Examples of Technique
NORMAL DISTRIBUTION CURVE
TITRATION AND TIME
SIGNS AND SYMPTOMS OF OVERSEDATION
Clinical Indicators of Oversedation
The Patient Persistently Closes the Mouth
The Patient Spontaneously Begins Mouth Breathing
The Patient Complains of Nausea and Effects of Sedation Felt as Too Intense or Uncomfortable
The Patient Fails to Respond Rationally or Gives Sluggish Responses
The Patient Begins to Lose Control
The Patient Speaks Incoherently or Dreams
The Patient Becomes Uncooperative
The Patient Laughs, Cries, or Becomes Giddy
The Patient Has Uncoordinated Movements
REFERENCES
027science
Inhalation Sedation: Complications
INADEQUATE OR INCOMPLETE SEDATION
POOR PATIENT EXPERIENCE
EQUIPMENT PERFORMANCE
POTENTIAL COMPLICATIONS
Nausea and Vomiting
Presence of Food in the Stomach
Oversedation
The “Roller Coaster Ride”
Length of Sedation
Prior History of Nausea and Vomiting
Patient Positioning
Management of Vomiting
Tooth Pain Associated With Sinus Pressure
Vertigo
Bowel Discomfort
Claustrophobia
Contact Lens Wearers
Anatomic Obstruction
Understanding of the Language
Esoteric Potential Complications
MANAGING COMPLICATIONS
REFERENCES
028science
Contemporary Issues Surrounding Nitrous Oxide
POTENTIAL BIOHAZARDS FROM LONG-TERM EXPOSURE TO TRACE ANESTHETIC GAS
Scavenging
Monitoring of Trace Nitrous Oxide
Bacharach Monitor
RECREATIONAL ABUSE OF NITROUS OXIDE
SEXUAL AWARENESS REGARDING NITROUS OXIDE
REFERENCES
029science
Practical Considerations
DETERMINATION OF PROPER TITRATION AT SUBSEQUENT VISITS
Procedural Anxiety
Baseline Level of Stress
Level of Fatigue
POOR PATIENT EVALUATION
PATIENT UNATTENDED DURING SEDATION
IMPROPER RECOVERY PROCEDURES
POSTSEDATION NAUSEA, HEADACHE, AND LETHARGY
WHO ADMINISTERS NITROUS OXIDE?
EQUIPMENT
REFERENCES
030science
Teaching Inhalation Sedation: History and Present Guidelines
GENERAL PRINCIPLES OF Minimal SEDATION
Education Courses
Teaching Administration of Minimal Sedation
General Objectives
INHALATION SEDATION (NITROUS OXIDE-OXYGEN)
Inhalation Sedation Course Objectives
Inhalation Sedation Course Content
Inhalation Sedation Course Duration
Participant Evaluation and Documentation of Inhalation Sedation Instruction
Faculty
Facilities
REFERENCES
031science
SECTION V INTRAVENOUS SEDATION
REFERENCES
032science
Intravenous Sedation: Historical Perspective
THE EARLY DAYS
THE 1800s
THE 1900s
REFERENCES
033science
Intravenous Moderate Sedation: Rationale
ADVANTAGES
DISADVANTAGES
CONTRAINDICATIONS
INDICATIONS
Anxiety
Amnesia
Medically Compromised Patients
Previous Cerebrovascular Accident
Epilepsy
Control of Secretions
Analgesia
Diminished Gagging
REFERENCES
034science
Armamentarium
INTRAVENOUS DRUG ADMINISTRATION
Direct Intravenous Administration
Needle Maintained in the Vein Without Continuous Infusion
Continuous Intravenous Infusion
ADVANTAGES AND DISADVANTAGES OF VARIOUS METHODS
INTRAVENOUS INFUSION SOLUTION
Choice of Solution
Volume of Solution
INTRAVENOUS ADMINISTRATION SET
NEEDLES
Gauge
Types
OTHER ITEMS
REFERENCES
035science
Anatomy for Venipuncture
ARTERIES OF THE UPPER LIMB
VEINS OF THE UPPER LIMB
ANATOMY
Dorsum of the Hand
Wrist
Forearm
Antecubital Fossa
Foot
SELECTION OF VENIPUNCTURE SITE
Condition of the Superficial Veins
Relationship of the Vein to Other Anatomic Structures
Duration of the Venipuncture
Clinical Status of the Patient
Age (Size) of the Patient
Type of Intravenous Procedure
RECOMMENDED SITES FOR VENIPUNCTURE
REFERENCES
036science
Venipuncture Technique
PREPARATION OF EQUIPMENT
PREPARATION FOR VENIPUNCTURE
INDWELLING CATHETER
WINGED INFUSION SET
Basic Technique—Winged Infusion Set
HOLLOW METAL NEEDLE
Basic Technique—Hollow Metal Needle
VENIPUNCTURE TECHNIQUE
Dorsum of Hand
Dorsum of Wrist
Ventral Forearm
Antecubital Fossa
TERMINATING THE INTRAVENOUS INFUSION
REFERENCES
037science
Pharmacology
BENZODIAZEPINES
Diazepam
Chemistry
General Pharmacology
Fate of Intravenous Diazepam
Biotransformation
Effects of Age and Disease
Skeletal Muscle Relaxation
Anticonvulsant Activity
Cardiovascular System
Respiratory System
Hepatic Disease
Pain
Amnesia
Contraindications
Warnings
Use in Pregnancy
Pediatric Use
Precautions
Adverse Reactions
Dosage
Availability
Midazolam
Pharmacokinetics and Biotransformation
Amnesia
Duration of Clinical Activity
Cardiorespiratory Activity
Side Effects
Dosage and Administration
Availability
Lorazepam
Warnings and Precautions
Pediatric Use
Adverse Reactions
Dosage
Administration
Availability
Flunitrazepam
Side Effects and Complications
Flunitrazepam Sedation in Dentistry
Availability
Chlordiazepoxide
SUMMARY
BARBITURATES
SUMMARY
HISTAMINE BLOCKERS (ANTIHISTAMINICS)
Promethazine
Dosage
Availability
SUMMARY
PROPOFOL
Pharmacodynamics
Central Nervous System
Respiratory System
Cardiovascular System
Miscellaneous Effects
Clinical Use
Warnings
Adverse Reactions
Dosage and Administration
Sedation
Availability
OPIOID ANALGESICS
OPIOID AGONISTS
Meperidine
Dosage
Availability
Morphine
Dosage
Availability
Fentanyl
Indications
Contraindications
Warnings
Precautions
Adverse Reactions
Dosage
Availability
Alfentanil, Sufentanil, and Remifentanil
Availability
OPIOID AGONIST-ANTAGONISTS
Pentazocine
Contraindications
Warnings
Precautions
Adverse Reactions
Dosage
Availability
Nalbuphine
Pharmacology
Pharmacokinetics
Adverse Effects
Overdose
Contraindications
Warnings
Precautions
Dosage
Availability
Butorphanol
Pharmacology
Pharmacokinetics
Effect on Respiration
Cardiovascular Effects
Side Effects
Overdose
Warnings
Precautions
Dosage
Availability
SUMMARY
OPIOID ANTAGONISTS
ANTICHOLINERGICS
Pharmacology
Mechanism of Action
Central Nervous System
Eye
Respiratory Tract
Cardiovascular Actions
Gastrointestinal Tract
Secretory Glands
Biotransformation
Atropine
Adverse Reactions
Dosage
Availability
Scopolamine Hydrobromide
Dosage
Availability
Glycopyrrolate
Warnings
Precautions
Dosage
Availability
SUMMARY
KETAMINE
ANTIDOTAL DRUGS
Opioid Antagonists
Naloxone
SUMMARY
Benzodiazepine Antagonist
Dosage
Availability
Reversal of Emergence Delirium
Physostigmine
SUMMARY
Vasodilator for Extravascular or Intraarterial Drug Administration
Procaine
REFERENCES
038science
Intravenous Moderate Sedation: Techniques of Administration
MONITORING DURING INTRAVENOUS SEDATION
BASIC INTRAVENOUS MODERATE SEDATION TECHNIQUES
Midazolam or Diazepam?
Intravenous Benzodiazepine (Midazolam or Diazepam)
Preliminary Appointment
Day of Treatment
Midazolam
Diazepam
Retitration of Midazolam or Diazepam
SUMMARY
MODIFICATIONS OF BASIC TECHNIQUES
Anticholinergic + Benzodiazepine
Technique
Opioid + Benzodiazepine
Rationale for Advanced Techniques
Requirement: Sedation
Requirement: Analgesia
Techniques
OTHER TECHNIQUES— A BRIEF REVIEW
The Jorgensen Technique—an Overview
Function of the Individual Drugs
Diazepam With Methohexital (Foreman Technique)
The Berns Technique
The Shane Technique
Propofol
SUMMARY
REFERENCES
039science
Intravenous Sedation: Complications
VENIPUNCTURE COMPLICATIONS
Nonrunning Intravenous Infusion
IV Infusion Bag Too Close to the Heart Level
Bevel of Needle Against Wall of Vein
Tourniquet Left on Arm
Infiltration
Venospasm
Prevention
Recognition
Management
Hematoma
Prevention
Recognition
Management
Infiltration
Prevention
Cause
Recognition
Management
Localized Venous Complications
Air Embolism
Management
Overhydration
LOCAL COMPLICATIONS OF DRUG ADMINISTRATION
Extravascular Drug Administration
Causes
Recognition
Intraarterial Injection
Prevention
Recognition
Management
Local Venous Complications
Prevention
Recognition
Management
GENERAL DRUG-RELATED COMPLICATIONS
Nausea and Vomiting
Causes of Nausea and Vomiting
Management of Nausea
Management of Vomiting
Localized Allergy
Respiratory Depression
Recognition
Management
Emergence Delirium
Prevention
Management
Laryngospasm
Recognition
Management
SPECIFIC DRUG COMPLICATIONS
Benzodiazepines
Promethazine
Opioids
Scopolamine
SUMMARY
REFERENCES
040science
Practical Considerations
REFERENCES
041science
Guidelines for Teaching
REFERENCES
042science
SECTION VI GENERAL ANESTHESIA
REFERENCEs
043science
Fundamentals of General Anesthesia
ADVANTAGES
DISADVANTAGES
CONTRAINDICATIONS
INDICATIONS
TYPES OF GENERAL ANESTHESIA
Outpatient General Anesthesia
Intravenous Propofol or Barbiturates
Conventional Operating Room Type of General Anesthesia in an Outpatient Environment
Inpatient General Anesthesia
EDUCATION IN GENERAL ANESTHESIA
Guidelines Relative to the Establishment of a Dental Residency in Anesthesiology
ACCREDITED ANESTHESIOLOGY RESIDENCIES IN WHICH DENTISTS CAN ENROLL
REFERENCES
044science
Armamentarium, Drugs, and Techniques
ARMAMENTARIUM
Anesthesia Machine
Intravenous Equipment
Ancillary Anesthesia Equipment
Face Masks
Laryngoscopes
Endotracheal Tubes and Connectors
Laryngeal Mask Airway (LMA)
Oropharyngeal and Nasopharyngeal Airways
Tonsillar Suction Tips
Magill Intubation Forceps
Sphygmomanometers and Stethoscopes
Monitoring Equipment
Emergency Equipment and Drugs
DRUGS
Intravenous Induction Agents
Barbiturates
Benzodiazepines
Other Agents
Opioids
Neuroleptanalgesia-Neuroleptanesthesia
Dissociative Anesthesia
Muscle Relaxants (Neuromuscular Blocking Drugs)
Inhalation Anesthetics
TECHNIQUES
Inpatient General Anesthesia
Ambulatory General Anesthesia
Conventional General Anesthetics
Intravenous General Anesthesia
SUMMARY
REFERENCES
045science
SECTION VII EMERGENCY PREPARATION AND MANAGEMENT
REFERENCES
046science
Preparation for Emergencies
OFFICE
OFFICE PERSONNEL
Basic Life Support
Advanced Cardiovascular Life Support
Pediatric Advanced Life Support
Team Approach to Emergency Management
EMERGENCY PRACTICE DRILLS
The Institute of Medical Emergency Preparedness (IMEP)*
OUTSIDE MEDICAL ASSISTANCE
SUMMARY
REFERENCES
047science
Emergency Drugs and Equipment
LEVEL 1: BASIC EMERGENCY KIT
Injectable Drugs
Noninjectable Drugs
Primary (Basic) Emergency Equipment
LEVEL 2: SECONDARY (NONCRITICAL) DRUGS AND EQUIPMENT
Injectable Drugs
Noninjectable Drugs
Secondary (Advanced) Emergency Equipment
LEVEL 3: ADVANCED CARDIAC LIFE SUPPORT
LEVEL 4: ANTIDOTAL DRUGS
SUMMARY
REFERENCES
048science
Management of Emergencies
OVERDOSE
Predisposing Factors and Prevention
Clinical Manifestations
Sedative-Hypnotics, Including Barbiturates
Opioid Agonists
Management
Sedative-Hypnotic Drugs
Opioid Analgesics
SUMMARY
ALLERGY
Prevention of Allergic Reactions
Clinical Manifestations
Onset
Skin Reaction
Respiratory Reactions
Generalized Anaphylaxis
Management
Skin Reactions
Respiratory Reactions
Generalized Anaphylaxis
Signs of Allergy Present
No Signs of Allergy Present
HYPOTENSION
Causes of Hypotension
Management of Hypotension
Hypotension in Patients Receiving Corticosteroid Therapy
Hypotension in Patients Receiving β-Blockers
HYPERTENSIVE EPISODES
Management of a Hypertensive Crisis
CARDIAC DYSRHYTHMIAS
Precipitating Factors
ANGINA PECTORIS
Signs and Symptoms
MYOCARDIAL INFARCTION
Signs and Symptoms
Management
AIRWAY OBSTRUCTION
Management
Partial Airway Obstruction Associated with “Snoring”
Partial Airway Obstruction Associated With “Gurgling”
Partial Airway Obstruction Associated With “Wheezing”
Cricothyrotomy
LARYNGOSPASM
Management
EMESIS AND ASPIRATION OF FOREIGN MATERIAL UNDER ANESTHESIA
Management
HYPERVENTILATION
Management
RESPIRATORY DEPRESSION
Management
SEIZURES
Management
HYPOGLYCEMIA
Management
SYNCOPE
Management
SUMMARY
REFERENCES
049science
SECTION VIII SPECIAL CONSIDERATIONS
REFERENCEs
050science
The Pediatric Patient
FACTORS INFLUENCING PATIENT RESPONSE
BEHAVIORAL EVALUATION OF THE PEDIATRIC PATIENT
DETERMINING THE NEED FOR SEDATION
GOALS AND TECHNIQUES
MONITORING
PHYSICAL RESTRAINT
MOUTH-STABILIZING DEVICES
DRUGS
General Rules for Preoperative Medication
Oral Sedation
Chloral Hydrate
Hydroxyzine
Promethazine
Midazolam
Diazepam
Oral Combinations
Chloral Hydrate Plus Promethazine
Promethazine Plus Meperidine
Parenteral Sedation
Meperidine Plus Promethazine
Lytic Cocktail
Midazolam
Ketamine
Inhalation Sedation
Dosage
Nitrous Oxide-Oxygen With Other Techniques
Intravenous Sedation
DISCHARGE FROM THE OFFICE
RECORDKEEPING
GENERAL ANESTHESIA
REFERENCES
051science
The Geriatric Patient*
COMMON HEALTH PROBLEMS
Arthritis
Hypertension
Heart Disease
Emphysema
Glaucoma
MANAGEMENT OF PAIN AND ANXIETY
REFERENCES
052science
The Medically Compromised Patient
CARDIOVASCULAR DISEASE
Angina Pectoris
Unstable Angina
Myocardial Infarction
High Blood Pressure
Dysrhythmias
Heart Failure
Congenital Heart Disease
Valvular Heart Disease
RENAL DISEASE
RESPIRATORY DISEASE
Asthma
Chronic Obstructive Pulmonary Disease
Emphysema
Chronic Bronchitis
NEUROLOGIC DISORDERS
Seizure Disorders
Cerebrovascular Accident
Myasthenia Gravis
LIVER DISEASE
ENDOCRINE DISORDERS
Thyroid Gland Dysfunction
Hyperthyroidism
Hypothyroidism
Adrenal Disorders
METABOLIC AND GENETIC DISORDERS
Diabetes Mellitus
Porphyria
Malignant Hyperthermia
Atypical Plasma Cholinesterase
HEMATOLOGIC DISORDERS
Anemia
Sickle Cell Anemia
Polycythemia Vera
Hemophilia
REFERENCES
053science
The Physically Compromised Patient
MULTIPLE SCLEROSIS
Environmental
Genetic
Immunologic
Viral
MUSCULAR DYSTROPHY
PARKINSON DISEASE
CEREBROVASCULAR ACCIDENT (CVA, STROKE, CEREBRAL ACCIDENT, “BRAIN ATTACK”)
REFERENCES
054science
Neurologic Illnesses and Other Conditions
ALZHEIMER DISEASE
AUTISM
CEREBRAL PALSY
DOWN SYNDROME
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
SCHIZOPHRENIA
REFERENCES
055science
Medicolegal Considerations
THE UNIQUE STATUS OF SEDATION IN DENTISTRY
LEGAL HISTORY
MODERN LIABILITY INSURANCE CRISES
LIABILITY INSURANCE COVERAGE
THEORIES OF LIABILITY
Statute Violation
Contract Law
Criminal Law
Tort Law
Duty
Breach of Duty
Causation
Damage
Reasonableness
Consent
Statute of Limitations
EMERGENCIES DURING SEDATION
Consent During Emergencies
Defining Emergency
Defining Sedation Emergencies
EMERGENCY RESCUES—GOOD SAMARITAN STATUTES
RELATIONSHIP BETWEEN DENTIST AND EMERGENCY PATIENT
Foreseeability
LIMITING LIABILITY FOR EMERGENCIES
Prevention and Preparation
Poor Decisions
Respondeat Superior
Community Standards
Professional Relationships
Collegiality
PHILOSOPHICAL ASPECTS OF TREATING EMERGENCIES
REFERENCES
056science
The Controversial Development of Anesthesiology in Dentistry
HORACE WELLS AND WILLIAM T.G. MORTON
EARLY RESISTANCE TO ANESTHESIA
PROFESSIONAL LITERATURE, THE DENTAL COSMOS
VARIED ANESTHESIA PROVIDERS
AMERICAN SOCIETY OF EXODONTISTS
ORAL AND MAXILLOFACIAL SURGERY ANESTHESIA PIONEERS
AMERICAN DENTAL SOCIETY OF ANESTHESIOLOGY
HISTORICAL DENTAL ANESTHESIOLOGY TRAINING
AMERICAN SOCIETY OF DENTIST ANESTHESIOLOGISTS
AMERICAN SOCIETY OF ORAL AND MAXILLOFACIAL SURGEONS
OFFICE ANESTHESIA EVALUATIONS
MEDICAL ANESTHESIA’S STATUS IN OFFICE-BASED ANESTHESIOLOGY
EXTRAPROFESSIONAL CRITICISM OF DENTAL ANESTHESIOLOGY
AAOMS RESPONSES
POSWILLO REPORT AND ALASKA
1990S DENTAL ANESTHESIOLOGY SPECIALTY APPLICATIONS
NEED AND DEMAND
ORAL SEDATION ENTREPRENEURIAL GROUPS
FROM THE SOCIETIES, STATES, CONGRESS, AND THE UNITED STATES SUPREME COURT
COMPETING DENTAL FACTIONS
FUTURE OF DENTAL ANESTHESIOLOGY
REFERENCES
057science
Guidelines for the Use of Parenteral Sedation: University of Southern California School of Dentistry
058science
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Y
Z
