There are many techniques used for conscious sedation. It can be pharmacological that is by using drugs to achieve the sedation or it can be by non pharmacological means that is by hypnosis. Basic purpose of sedation is to make the patient free from anxiety and fear of dentistry. So many people they avoid going to the dentist because they are afraid of dentistry. Either they have previous bad experience or they have hear from their friends or peer group. The benefit of sedation is that we can have a calm and anxiety free patient in the dental office that is not afraid of dentistry. We can discuss with the patient about the various techniques of the sedation like oral sedation, inhalation sedation or the IV sedation. The most commonly techniques used are inhalation sedation and the oral sedation.
Pharmacosedation - Techniques of sedation requiring the administration of drugs to achieve a desirable clinical effect.
Latrosedation - Those that do not require administration of drugs.
Latrosedation - Defined as the relief of anxiety through the doctor’s behavior. It is the building block for all other forms of psychosedation.
Simply stated, iatrosedation is a technique of communications b/w the doctor and the patient that creates a bond of trust and confidence.
Patients possessing trust and confidence in their doctor are well on their way to being more relaxed and co-operative
Another benefit : Prevention of possible medicolegal complications.
In some situations iatrosedation alone may remove all of the patients fears and anxieties concerning the treatment, permitting us to then proceed in a normal manner, without the need for pharmacosedation. More often, however, iatrosedation produces a decrease in the patients level of anxiety to the point that use of supplemental pharmacosedation will enable the patient to more readily accept and tolerate the planned treatment.
a) Hypnosis: When employed by a trained hypnotherapist, in the proper clinical environment, and on an appropriate patient, hypnosis has proved to be a highly effective means of achieving both relaxed and a pain – tree treatment environment.
g) Electronic Dental Anesthesia (Eda).
Drugs may be administered through 14 routes. The first 13 of these routes are used within the practice of medicine, with the first 10 used in dentistry. The last one is used in veterinary medicine. These routes are as follows:
12. Intrathecal (within the spinal cord)
Advantages of oral sedation
Disadvantages of oral sedation
Advantages of inhalational sedation
1. Rapid onset
a). Oral à 30 min onset.
b). IM à 10-15 min.
c). Rectal – 30 min
d). IV – 20 sec.
e). Inhalation - < 20 sec is pulmonary circulation to brain time.
2. Depth of sedation: may be altered from moment to moment, permitting drug administrator to increase or decrease the depth of sedation.
3. Duration of action: in situations in which a sedation technique has a relatively fixed duration of action, the planned procedure may be of any length, foreg., a minute or so for the taking of radiographs or 3 to 4 hours for preparation and impression of multiple tooth preparations for fixed bridgework.
4. No injection is required with inhalation sedation
5. Very few side effects associated with inhalational sedation with nitrous oxide and oxygen.
6. The drugs used in this technique have no adverse effects on liver, kidneys, brain, or heart.
Disadvantages of inhalational sedation
Complications of inhalation sedation :
a) Excessive perspiration.
b) Behavioural problems.
Advantages of intravenous sedation
Disadvantages of intravenous sedation
Advantages of rectal sedation
Disadvantages of rectal sedation
a). Late onset of action.
b). Deeper levels of anesthesia not obtained.
The administration of drugs through skin has existed for a long time. Previously the ointments and lotions are used for skin problems. That is also the transdermal route. So transdermal system consists the medications which are used topically and the active ingredient goes into systemic circulation. So basically it is the topically applied sedatives.
Advantages of transdermal sedation
Disadvantages of transdermal sedation
INTRAMUSCULAR SEDATION :
IM route of drug administration is a parenteral technique in which the drug enters the CVS system without 1st passing through the G.I. system.
Advantages of intramuscular sedation
Disadvantages of intramuscular sedation
Use of IM route :
1. For sedation in the following types of patients :
a) The adult patient, when inhalation and I.V routes are unavailable.
b) Disruptive pediatric adult patient in whom other routes have proved ineffective.
2.Other uses :
a) Premeditation before IV sedation or G.A. in the pre-cooperative pediatric patient or adult or patient with disabilities.
b) Administration of antiemetics or anticholinergics.
c) Administration of emergency drugs when IV administration is not available.
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