1. 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

2. Hospital Experience -Elements
Out patients clinics
Consulting – Teams
Education
General anesthesia

3. 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

4. General Anesthesia - Questions ???
Kinds of individuals treated
Criteria
Process an individual goes through
Induction methods
Safety precautions
Common complications
Common post operative psychological complications

5. General Anesthesia Methods to reduce post-operative complications
Methods to decrease psychological effects

6. Primary goal of sedation
Facilitate provision of quality care by diminishing anxiety and managing disruptive behavior
produce a positive attitude toward dental care

7. If the only tool is a hammer
Then every problem is a nail

8. General consideration
Nature of treatment challenge
Planned dental procedure
duration
invasivity
equipment
Ability of care giver to provide post-operative care

9. 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

10. Sedation _Indications
Differentiate between mild conscious sedation and heavy sedation \or
Preventive - anxiolytic sedation and Management sedation

11. Preventive sedation

12. Ideal requirements Safe rapid onset well tolerated
minimal side effects
reversible
rapid dissolution

13. Management medication

14. Why do we fail :

15. RCDS Guidelines Undergrad education

16. Some of the commonly used drugs in pediatrics
Nitrous oxide
antihistamines - hydroxazine - vistaril
anxiolytics - medazolam
- valium
- diazepam derivatives
sedative-hypnotics - chloral-hydrate
dissociatives - ketamine
narcotics - Demerol

17. Routes of administration
Oral
Intra-nasal
Sublingual
Rectal IM IV

18. Antihistamines Adv.. - sedative, antihistaminic, antiemetic,
anticholinergic -
Disad. - non-analgesic, non-amnesic, non anxiolytic

19. Atarax -Indications Preschool and younger children
Timid highly anxious , high strung
Preventive medication
Extensive amount of treatment required

20. Atarax- Contraindications
Previous history of hypersensitivity
glaucoma
Inability to obtain communication

21. Atarax Dosage : .5-2.5mg\kg// 1mg/lb
PO Divided dosages - 1and2 hrs prior to apt.
2yr old - 20lbs - 20mg
3yr old - 30lbs -30 mg
4yr old - 40lbs - 40mg
5yr old - 50lbs - 50mg max dose

22. 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

23. 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 .