Additional Information
Book Details
Abstract
Learn how to safely sedate your dental patients and help control their anxiety with Sedation: A Guide to Patient Management, 6th Edition. Written by sedation expert Stanley Malamed, DDS, this concise guide combines essential theory with "how-to" technical instruction to help you master basic techniques in dental sedation and anxiety control. This new sixth edition also incorporates the latest guidelines from the ADA and the American Society of Anesthesiologists, along with vivid images of the most current equipment and procedures used in dental practice today. There is also detailed discussion on how to modify typical treatment protocol to successfully treat different patient populations — including pediatric, geriatric, physically compromised, and medically compromised patients. In all, this is a must-have guide for keeping up to date on the latest techniques in dental sedation and anxiety.
- The latest practice guidelines established by the ADA and the American Society of Anesthesiologists for sedation by non-anesthesiologists are included throughout the text.
- Comprehensive coverage combines all aspects of sedation with essential theory and instruction to cover all the information needed to provide safe and effective dental care.
- Expert authorship from Stanley Malamed, DDS, provides readers with experienced guidance across all areas of sedation dentistry and local anesthesia.
- Summary tables and boxes support visual learners and serve as useful review and study tools.
- Coverage of all potential patient groups details how to manage the pain and anxiety of pediatric, geriatric, physically compromised, and medically compromised patients in addition to the subtle changes that may be needed in normal treatment protocol.
- NEW! Extensive content revisions incorporate the most up-to-date information on the advances in sedation dentistry including the latest research, clinical experience, and literature.
- NEW! Updated photos and art reflect the latest equipment and procedures used in dental practice today.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Sedation | i | ||
| Copyright Page | ii | ||
| Dedication | iii | ||
| Contributors | iv | ||
| Preface | v | ||
| Reference | v | ||
| About This Book | vi | ||
| Acknowledgments | vii | ||
| Sedation in Dentistry: A Historic Perspective | viii | ||
| References | ix | ||
| Table Of Contents | xi | ||
| I Introduction | 1 | ||
| 1 Pain and Anxiety in Dentistry | 2 | ||
| Chapter Outline | 2 | ||
| Basic Fears | 4 | ||
| Dental Fears | 5 | ||
| References | 7 | ||
| II Spectrum of Pain and Anxiety Control | 8 | ||
| Reference | 9 | ||
| 2 Introduction to Sedation | 10 | ||
| Chapter Outline | 10 | ||
| Definitions | 10 | ||
| The Concept of “Rescue” | 12 | ||
| Summary | 12 | ||
| References | 13 | ||
| 3 The Spectrum of Pain and Anxiety Control | 14 | ||
| Chapter Outline | 14 | ||
| No Anesthesia | 15 | ||
| Iatrosedation | 15 | ||
| Other Nondrug Psychosedative Techniques | 16 | ||
| Routes of Drug Administration | 16 | ||
| Oral | 16 | ||
| Rectal | 18 | ||
| Topical | 18 | ||
| Sublingual | 18 | ||
| Intranasal | 18 | ||
| Transdermal | 18 | ||
| Subcutaneous | 18 | ||
| Intramuscular | 18 | ||
| Inhalation (Pulmonary) | 19 | ||
| Intravenous | 20 | ||
| General Anesthesia | 21 | ||
| References | 21 | ||
| 4 Physical and Psychological Evaluation | 23 | ||
| Chapter Outline | 23 | ||
| Goals of Physical and Psychological Evaluation | 23 | ||
| Physical Evaluation | 24 | ||
| Medical History Questionnaire | 24 | ||
| Physical Examination | 47 | ||
| Vital Signs | 48 | ||
| Blood Pressure | 48 | ||
| Technique. | 48 | ||
| Common errors in technique. | 49 | ||
| Guidelines for clinical evaluation. | 51 | ||
| Heart Rate and Rhythm | 51 | ||
| Technique. | 51 | ||
| Guidelines for clinical evaluation. | 52 | ||
| Respiratory Rate | 53 | ||
| III Oral, Rectal, and Intramuscular Sedation | 94 | ||
| 7 Oral Sedation | 95 | ||
| Chapter Outline | 95 | ||
| Advantages | 95 | ||
| Disadvantages | 96 | ||
| Absorption | 97 | ||
| Bioavailability | 98 | ||
| Rationale for Use | 98 | ||
| Drugs | 99 | ||
| Antianxiety Drugs | 100 | ||
| Benzodiazepine Antianxiety Agents | 100 | ||
| Pharmacology | 101 | ||
| Mode of Action | 101 | ||
| Central Nervous System | 101 | ||
| Respiratory System | 101 | ||
| Cardiovascular System | 101 | ||
| Liver | 101 | ||
| Absorption, Metabolism, Excretion | 101 | ||
| Dependence | 102 | ||
| Oral Benzodiazepines in Dentistry | 102 | ||
| Contraindications | 103 | ||
| Warnings | 103 | ||
| Benzodiazepines in Children | 103 | ||
| Drug Interactions | 103 | ||
| Precautions | 103 | ||
| Adverse Reactions | 103 | ||
| Chlordiazepoxide | 103 | ||
| Diazepam | 103 | ||
| IV Inhalation Sedation | 164 | ||
| References | 166 | ||
| 11 Inhalation Sedation | 167 | ||
| Chapter Outline | 167 | ||
| Beginnings (Pre-1844) | 167 | ||
| The Early Days (1844–1862) | 168 | ||
| Anesthesia Develops (1863–1898) | 174 | ||
| The Twentieth Century | 175 | ||
| Modern Times (1950–Present) | 177 | ||
| The Development of Courses and Guidelines | 177 | ||
| The Early Anesthesia Machine | 178 | ||
| References | 179 | ||
| 12 Inhalation Sedation | 180 | ||
| Chapter Outline | 180 | ||
| Advantages | 180 | ||
| Disadvantages | 182 | ||
| Indications | 183 | ||
| Anxiety | 183 | ||
| Medically Compromised Patients | 183 | ||
| Cardiovascular Disease | 183 | ||
| Respiratory Disease | 184 | ||
| Cerebrovascular Disease | 184 | ||
| Hepatic Disease | 184 | ||
| Epilepsy and Seizure Disorders | 184 | ||
| Pregnancy | 184 | ||
| Allergy | 185 | ||
| Diabetes | 185 | ||
| Gagging | 185 | ||
| Contraindications | 185 | ||
| Patients With a Compulsive Personality | 185 | ||
| Claustrophobic Patients | 185 | ||
| Children With Severe Behavior Problems | 185 | ||
| Patients With Severe Personality Disorders | 185 | ||
| Upper Respiratory Tract Infection or Other Acute Respiratory Conditions | 185 | ||
| Chronic Obstructive Pulmonary Disease | 186 | ||
| The Patient Who Does Not Want N2O-O2 | 186 | ||
| Pregnancy | 186 | ||
| Restorative Dentistry | 186 | ||
| Initial Dental Examination | 186 | ||
| Removal of Provisional Crowns or Bridges | 186 | ||
| Occlusal Adjustment | 186 | ||
| Insertion of Matrix Bands or Wedges | 186 | ||
| Periodontics and Dental Hygiene | 186 | ||
| Initial Periodontal Examination | 187 | ||
| Scaling, Curettage, and Root Planing | 187 | ||
| Use of Ultrasonic Instruments | 187 | ||
| Periodontal Surgery | 187 | ||
| Oral and Maxillofacial Surgery | 187 | ||
| Lengthy Surgical Procedures | 187 | ||
| Management of Abscesses | 187 | ||
| Management of Postoperative Complications | 187 | ||
| Suture Removal | 187 | ||
| Endodontics | 187 | ||
| Rubber Dam Clamps | 187 | ||
| Gaining Access to the Pulp Chamber | 188 | ||
| Instrumenting Canals | 188 | ||
| Filling of Root Canals | 188 | ||
| Fixed Prosthodontics | 188 | ||
| Impression Taking | 188 | ||
| Removal of Provisional Crowns and Bridges | 188 | ||
| Adjustment of Castings | 188 | ||
| Removable Prosthodontics | 188 | ||
| Preparation of Abutment Teeth | 188 | ||
| Determination of Centric Relationships | 188 | ||
| Occlusal Adjustments and Impression Taking | 188 | ||
| Fitting of Immediate Dentures | 188 | ||
| Oral Radiology | 189 | ||
| Orthodontics | 189 | ||
| Pediatric Dentistry | 189 | ||
| References | 189 | ||
| 13 Pharmacology, Anatomy, and Physiology | 190 | ||
| Chapter Outline | 190 | ||
| Pharmacology | 190 | ||
| Nitrous Oxide | 190 | ||
| Preparation | 190 | ||
| Properties | 191 | ||
| Physical Properties | 191 | ||
| Chemical Properties | 191 | ||
| Solubility | 191 | ||
| Potency | 192 | ||
| Pharmacology | 192 | ||
| Central Nervous System | 194 | ||
| Cardiovascular System | 194 | ||
| Respiratory System | 194 | ||
| Gastrointestinal Tract | 194 | ||
| Kidneys | 194 | ||
| Hematopoiesis | 194 | ||
| Skeletal Muscle | 194 | ||
| Uterus and Pregnancy | 194 | ||
| Physiologic Contraindications | 195 | ||
| Oxygen | 195 | ||
| Preparation | 195 | ||
| Properties | 195 | ||
| Effects of 100% Oxygen | 195 | ||
| Central Nervous System | 195 | ||
| Cardiovascular System | 195 | ||
| V Intravenous Sedation | 273 | ||
| References | 274 | ||
| 20 Intravenous Sedation | 275 | ||
| Chapter Outline | 275 | ||
| The Early Days | 275 | ||
| The 1800S | 276 | ||
| The 1900S | 277 | ||
| References | 278 | ||
| 21 Intravenous Moderate Sedation | 279 | ||
| Chapter Outline | 279 | ||
| Advantages | 279 | ||
| Disadvantages | 280 | ||
| Contraindications | 281 | ||
| Indications | 282 | ||
| Anxiety | 282 | ||
| Amnesia | 283 | ||
| Medically Compromised Patients | 283 | ||
| Previous Cerebrovascular Accident | 283 | ||
| Epilepsy | 283 | ||
| Control of Secretions | 284 | ||
| Analgesia | 284 | ||
| Diminished Gag Reflex | 284 | ||
| References | 284 | ||
| 22 Armamentarium | 285 | ||
| Chapter Outline | 285 | ||
| Intravenous Drug Administration | 285 | ||
| Direct Intravenous Administration | 285 | ||
| Needle Maintained in the Vein Without Continuous Infusion | 285 | ||
| Continuous Intravenous Infusion | 285 | ||
| Advantages and Disadvantages of Various Methods | 286 | ||
| Intravenous Infusion Solution | 287 | ||
| Choice of Solution | 287 | ||
| Volume of Solution | 287 | ||
| Intravenous Administration Set | 288 | ||
| Needles | 290 | ||
| Gauge | 290 | ||
| Types | 291 | ||
| Other Items | 294 | ||
| References | 297 | ||
| 23 Anatomy for Venipuncture | 298 | ||
| Chapter Outline | 298 | ||
| Arteries of the Upper Limb | 298 | ||
| Veins of the Upper Limb | 300 | ||
| Anatomy | 300 | ||
| Dorsum of the Hand | 301 | ||
| Wrist | 301 | ||
| Forearm | 302 | ||
| Antecubital Fossa | 302 | ||
| Foot | 303 | ||
| Selection of Venipuncture Site | 304 | ||
| Condition of the Superficial Veins | 304 | ||
| Relationship of the Vein to Other Anatomic Structures | 304 | ||
| Duration of the Venipuncture | 304 | ||
| Clinical Status of the Patient | 304 | ||
| Age (Size) of the Patient | 304 | ||
| Type of Intravenous Procedure | 305 | ||
| Recommended Sites for Venipuncture | 305 | ||
| References | 307 | ||
| 24 Venipuncture Technique | 308 | ||
| Chapter Outline | 308 | ||
| Preparation of Equipment | 308 | ||
| Preparation for Venipuncture | 309 | ||
| Indwelling Catheter | 312 | ||
| Winged Infusion Set | 313 | ||
| Basic Technique—Winged Infusion Set | 313 | ||
| Hollow Metal Needle | 314 | ||
| Basic Technique—Hollow Metal Needle | 314 | ||
| Venipuncture Technique | 314 | ||
| Dorsum of Hand | 314 | ||
| Dorsum of Wrist | 316 | ||
| Ventral Forearm | 316 | ||
| Antecubital Fossa | 316 | ||
| Terminating the Intravenous Infusion | 317 | ||
| References | 318 | ||
| 25 Pharmacology | 319 | ||
| Chapter Outline | 319 | ||
| Benzodiazepines | 319 | ||
| Diazepam | 320 | ||
| Chemistry | 321 | ||
| General Pharmacology | 321 | ||
| Fate of Intravenous Diazepam | 321 | ||
| Biotransformation | 322 | ||
| Effects of Age and Disease | 322 | ||
| Skeletal Muscle Relaxation | 322 | ||
| Anticonvulsant Activity | 323 | ||
| Cardiovascular System | 323 | ||
| Respiratory System | 323 | ||
| Hepatic Disease | 323 | ||
| Pain | 323 | ||
| Amnesia | 323 | ||
| Contraindications | 324 | ||
| Warnings | 324 | ||
| Use in Pregnancy | 324 | ||
| Pediatric Use | 324 | ||
| Precautions | 324 | ||
| Adverse Reactions | 324 | ||
| Dosage | 325 | ||
| Availability | 325 | ||
| Midazolam | 325 | ||
| Pharmacokinetics and Biotransformation | 326 | ||
| Amnesia | 326 | ||
| Duration of Clinical Activity | 326 | ||
| Cardiorespiratory Activity | 327 | ||
| Side Effects | 327 | ||
| Dosage and Administration | 327 | ||
| Availability | 327 | ||
| Lorazepam | 328 | ||
| Warnings and Precautions | 328 | ||
| Pediatric Use | 328 | ||
| Adverse Reactions | 329 | ||
| Dosage | 329 | ||
| Administration | 329 | ||
| Availability | 329 | ||
| Flunitrazepam | 329 | ||
| Side Effects and Complications | 330 | ||
| Flunitrazepam Sedation in Dentistry | 330 | ||
| Availability | 330 | ||
| Chlordiazepoxide | 330 | ||
| Summary | 330 | ||
| Barbiturates | 330 | ||
| VI General Anesthesia | 405 | ||
| References | 406 | ||
| 30 Fundamentals of General Anesthesia | 407 | ||
| Chapter Outline | 407 | ||
| Types of General Anesthesia Used in Dentistry | 407 | ||
| Advantages | 408 | ||
| Disadvantages | 410 | ||
| Indications | 411 | ||
| Contraindications | 412 | ||
| Benefits of Outpatient vs. Inpatient General Anesthesia | 412 | ||
| Quality | 412 | ||
| Cost | 412 | ||
| Psychological Benefits | 412 | ||
| Reduced Exposure to Nosocomial Infections | 412 | ||
| Time | 413 | ||
| Availability | 413 | ||
| Parental Preference | 413 | ||
| Dentist Preference | 413 | ||
| Safety | 413 | ||
| Special Considerations for Dentistry | 413 | ||
| Education in Dental Anesthesia | 413 | ||
| Guidelines Relative to the Establishment of a Dental Residency in Anesthesiology | 413 | ||
| State Regulations | 414 | ||
| Associations | 415 | ||
| References | 415 | ||
| 31 Armamentarium, Drugs, and Techniques | 416 | ||
| Chapter Outline | 416 | ||
| Armamentarium | 416 | ||
| Anesthesia Machine | 416 | ||
| Intravenous Equipment | 417 | ||
| Ancillary Anesthesia Equipment | 417 | ||
| Anesthesia Face Masks | 417 | ||
| Laryngoscopes | 418 | ||
| Endotracheal Tubes and Connectors | 418 | ||
| Laryngeal Mask Airway | 419 | ||
| Oropharyngeal and Nasopharyngeal Airways | 419 | ||
| Tonsillar Suction Tips | 421 | ||
| Magill Intubation Forceps | 421 | ||
| Sphygmomanometers and Stethoscopes | 421 | ||
| Monitoring Equipment | 422 | ||
| Emergency Equipment and Drugs | 423 | ||
| Drugs | 423 | ||
| Intravenous Induction Agents | 424 | ||
| Barbiturates | 424 | ||
| Benzodiazepines | 424 | ||
| Other Agents | 425 | ||
| Opioids | 425 | ||
| Neuroleptanalgesia-Neuroleptanesthesia | 426 | ||
| Dissociative Anesthesia | 426 | ||
| Muscle Relaxants (Neuromuscular Blocking Drugs) | 427 | ||
| Inhalation Anesthetics | 428 | ||
| Techniques | 430 | ||
| Ideal Techniques | 430 | ||
| Preoperative Procedure | 430 | ||
| Preinduction | 431 | ||
| Intramuscular Ketamine | 431 | ||
| Intramuscular Ketamine + Midazolam | 431 | ||
| Intramuscular Ketamine + Midazolam + Anticholinergic | 431 | ||
| Mask Induction of Sevoflurane | 431 | ||
| Premedication | 431 | ||
| Induction | 431 | ||
| Airway Management | 431 | ||
| Nasopharyngeal Airway | 431 | ||
| Intubation | 431 | ||
| Laryngeal Mask Airway | 431 | ||
| Anesthesia Maintenance | 432 | ||
| Ending the Case | 432 | ||
| Summary | 432 | ||
| References | 433 | ||
| VII Emergency Preparation and Management | 434 | ||
| References | 436 | ||
| 32 Preparation for Emergencies | 437 | ||
| Chapter Outline | 437 | ||
| Office | 437 | ||
| Office Personnel | 437 | ||
| Basic Life Support | 437 | ||
| Advanced Cardiovascular Life Support | 438 | ||
| Pediatric Advanced Life Support | 438 | ||
| Team Approach to Emergency Management | 439 | ||
| Emergency Practice Drills | 439 | ||
| Outside Medical Assistance | 440 | ||
| Summary | 441 | ||
| References | 441 | ||
| 33 Emergency Drugs and Equipment | 442 | ||
| Chapter Outline | 442 | ||
| Level 1: Basic Emergency Kit | 445 | ||
| Injectable Drugs | 445 | ||
| Noninjectable Drugs | 445 | ||
| Primary (Basic) Emergency Equipment | 447 | ||
| Level 2: Secondary (Noncritical) Drugs and Equipment | 449 | ||
| Injectable Drugs | 449 | ||
| Noninjectable Drugs | 451 | ||
| Secondary (Advanced) Emergency Equipment | 451 | ||
| Level 3: Advanced Cardiac Life Support | 453 | ||
| Level 4: Antidotal Drugs | 453 | ||
| Summary | 454 | ||
| References | 454 | ||
| 34 Management of Emergencies | 456 | ||
| Chapter Outline | 456 | ||
| Overdose | 457 | ||
| Predisposing Factors and Prevention | 458 | ||
| Clinical Manifestations | 459 | ||
| Sedative-Hypnotics, Benzodiazepines, and Barbiturates | 459 | ||
| Minimal Sedation, Moderate Sedation, and Deep Sedation | 459 | ||
| General Anesthesia | 460 | ||
| Respiratory Arrest | 460 | ||
| Opioid Agonists | 460 | ||
| Management | 461 | ||
| Sedative-Hypnotic Drugs | 461 | ||
| Opioid Analgesics | 463 | ||
| Summary | 465 | ||
| Allergy | 467 | ||
| Prevention of Allergic Reactions | 468 | ||
| Clinical Manifestations | 468 | ||
| Onset | 468 | ||
| Skin Reaction | 468 | ||
| Respiratory Reactions | 469 | ||
| Generalized Anaphylaxis | 469 | ||
| Management | 470 | ||
| Skin Reactions | 470 | ||
| Delayed Skin Reactions | 470 | ||
| Immediate Skin Reactions | 470 | ||
| Respiratory Reactions | 470 | ||
| Bronchospasm | 470 | ||
| Laryngeal Edema | 471 | ||
| Generalized Anaphylaxis | 473 | ||
| Signs of Allergy Present | 473 | ||
| No Signs of Allergy Present | 474 | ||
| Hypotension | 475 | ||
| Causes of Hypotension | 475 | ||
| Management of Hypotension | 476 | ||
| Hypotension in Patients Receiving Corticosteroid Therapy | 478 | ||
| Hypotension in Patients Receiving β-Blockers | 478 | ||
| Hypertensive Episodes | 478 | ||
| Management of a Hypertensive Crisis During Sedation or General Anesthesia | 479 | ||
| Cardiac Dysrhythmias | 480 | ||
| Precipitating Factors | 481 | ||
| Angina Pectoris | 481 | ||
| VIII Special Considerations | 495 | ||
| References | 496 | ||
| 35 The Pediatric Patient | 497 | ||
| Chapter Outline | 497 | ||
| Factors Influencing Patient Response | 497 | ||
| Behavioral Evaluation of the Pediatric Patient | 499 | ||
| The Functional Inquiry | 499 | ||
| Determining the Need for Sedation | 500 | ||
| Caleb’s Law | 500 | ||
| Goals and Techniques | 501 | ||
| Determination of Drug Dosage for Pediatric Patients | 502 | ||
| Monitoring | 503 | ||
| Physical Restraint | 503 | ||
| Mouth-Stabilizing Devices | 504 | ||
| Drugs | 505 | ||
| Goals of Sedation in the Pediatric Patient | 505 | ||
| General Rules for Preoperative Medication | 506 | ||
| Oral Sedation | 507 | ||
| Chloral Hydrate | 507 | ||
| Initial Dosage | 507 | ||
| Hydroxyzine | 508 | ||
| Dosage | 508 | ||
| Promethazine | 508 | ||
| Initial Dosage | 508 | ||
| Midazolam | 508 | ||
| Index | 605 | ||
| A | 605 | ||
| B | 606 | ||
| C | 607 | ||
| D | 608 | ||
| E | 609 | ||
| F | 609 | ||
| G | 610 | ||
| H | 610 | ||
| I | 611 | ||
| J | 612 | ||
| K | 612 | ||
| L | 612 | ||
| M | 613 | ||
| N | 614 | ||
| O | 615 | ||
| P | 616 | ||
| Q | 617 | ||
| R | 617 | ||
| S | 618 | ||
| T | 619 | ||
| U | 619 | ||
| V | 619 | ||
| W | 620 | ||
| Y | 620 | ||
| Z | 620 |