Hospital Patient-Difficult Patient

What kinds of patients seen in hospital setting

Elements of hospital experience What constitutes a difficult pediatric

patient Classification of sedation agents Considerations for use

Hospital Experience -Elements

Out patients clinicsConsulting – Teams EducationGeneral anesthesia

ASA Classification

1_ - no systemic disease, normal healthy patient

2 - one mild systemic disease- ( cold, asthma, heart murmur)

3 -severe systemic disease that limits activity but not incapacitating

4 - incapacitating dss constant threat to life 5- moribund patient- survival without

treatment questionable

General Anesthesia - Questions ???

Kinds of individuals treatedCriteria Process an individual goes throughInduction methods Safety precautions Common complications Common post operative psychological

complications

General Anesthesia

Methods to reduce post-operative complications

Methods to decrease psychological effects

Primary goal of sedation

Facilitate provision of quality care by diminishing anxiety and managing disruptive behavior

produce a positive attitude toward dental care

If the only tool is a hammer

Then every problem is a nail

General consideration

Nature of treatment challenge Planned dental procedure

durationinvasivitytechnical @ equipment

Ability of care giver to provide post-operative care

Sedation

Defn: - A controlled pharmacologically induced, minimally depressed level of consiousness

Patient retains ability to maintain a patent airway independantly and continually- intact reflexes

Responds to physical, or verbal stimulation

Sedation _Indications

Differentiate between mild conscious sedation and heavy sedation \or

Preventive - anxiolytic sedation and Management sedation

Preventive sedation

Ideal requirements

Saferapid onsetwell toleratedminimal side effectsreversiblerapid dissolution

Management medication

Why do we fail :

RCDS Guidelines Undergrad education

Some of the commonly used drugs in pediatrics

Nitrous oxide antihistamines - hydroxazine - vistaril anxiolytics - medazolam - valium - diazepam derivatives sedative-hypnotics - chloral-hydrate dissociatives - ketaminenarcotics - Demerol

Routes of administration

Oral Intra-nasal Sublingual Rectal IM IV

Antihistamines

Adv.. - sedative, antihistaminic, antiemetic,

anticholinergic -

Disad. - non-analgesic, non-amnesic, non- anxiolytic

Atarax -Indications

Preschool and younger children Timid highly anxious , high strung Preventive medication Extensive amount of treatment

required

Atarax- Contraindications

Previous history of hypersensitivity glaucomaInability to obtain communication

Atarax

Dosage : .5-2.5mg\kg// 1mg/lb PO Divided dosages -

1and2 hrs prior to apt.2yr old - 20lbs - 20mg 3yr old - 30lbs -30 mg4yr old - 40lbs - 40mg5yr old - 50lbs - 50mg max dose

Hydroxazine -Atarax

Actions calming effect -sedative properties subdues exaggerated responses to

stimuli without dulling the senses antiemetic antispasmodic - acts on hypothalamus effects within 30 minutes action 3-4 hrs WIDE MARGIN SAFETY

Any Behavior Management technique should produce a positive psychologic response to treatment by helping the child get through a difficult treatment without a negative response .