CONSCIOUS

SEDATION
DEFINITION:
 A minimally depressed level
of consciousness that retains
the patients ability to maintain
airway independently and
respond appropriately to
physical stimulation and verbal
command.
 OBJECTIVES
 The patients mood should be altered.
 Patient should be conscious, respond to verbal
stimuli.
 Patient should be co-operative.
 All protective reflexes should be intact.
 Vital signs stable and normal.
 Child’s pain threshold should be
increased.
 Amnesia should occur.
 INDICATIONS:
 Patients who cannot cooperate or
understand for definitive treatment.
 Patient lacking cooperation because of
lack of psychological or emotional
maturity.
 Patients with dental care requirements
but are fear full and anxious.
 If long procedures are advocated for a
nervous and apprehensive child.
Routes of Administration

 INHALATIONAL (N2O)
 ENTERAL ( ORAL OR RECTAL)
 PARENTERAL -Intramuscular
- Subcutaneous
- Intranasal
- Submucosal
- Intravenous
. Oral Route
ADVANTAGES:
Convenience
Economy
Lack of toxicity.
Often Painless
DISADVANTAGES:
1. Variability of Effect:-
(a) Absorption of the drug from the gastrointestin
tract can be altered by several factors such as
- Presence of Food.
- Autonomic tone
- Fear
- Emotional make-up
- Fatigue
- Medications and
- Gastric empting time.
b). If absorption of the initial dose has
been delayed for any reason and a
second dose is subsequently given on the
assumption that the first dose was
ineffective. Both dose will eventually be
absorbed, possibly resulting in a high
serum level of the CNS- depressant
drug and leading to possible serious
consequences, such as respiratory
arrest, cardiovascular collapse and
death
c) The patient may not cooperative in
ingesting the medication or may vomit,
making estimation of the dose actually
received impossible.

2. Onset Time:
Intra muscular-
Route
Advantages:
Faster absorption
Technical Advantages:-
It requires no special equipment
little or no patient cooperation is
required
full calculated dose can be given with
a high degree of certainty.
 Disadvantages:
 Onset: Absorption of the injected
drug can be decreased or delayed by
several factors
.
A patient who is cold or very anxious
may experience peripheral vaso
constriction in the area of the injection
significantly decrease the rate of
absorption.
Biggest variable in onset is related to
where the drug is actually deposited.
 Effect:- Variable effect in some
children

 Trauma Proper selection of

injection site and proper technique
minimizes the possibility of tissue
trauma

 Intravenous Access
Subcutaneou
s Route
ADVANTAGES:-
 Site:- More comfortable
and convenient for the
dentist as well as the
patient
 Disadvantages:
 The rate of absorption is slower because
of lesser blood supply.

 Tissue Slough: Because the drug is

deposited close to the surface of the
skin or mucosa, tissue sloughing is
possible.

 Liability Costs:
 Intravenous
Route:
ADVANTAGES:-

Titration: - Small increments of doses may

be given over a short period of time until
the desired effect is achieved

Test Dose:
Intravenous Access:
DISADVANTAGES:-
Intravenous Access is
difficult
Placement & maintenance of
I.V. Catheter is difficult.
Require both training &
Extensive Practice.
 Agents in
Conscious
Sedation
Sedative-hypnotics.
Anti-anxiety agents.
Narcotic analgesics
 SEDATIVE & HYPNOTICS

Name of Mode of Effect Side

drug action effects
Chlorhy- Inhibiting •Introduce Gastric
the reticular sedation
drate •Decrease irritabili
activating
System
anxiety ty
•Increase
pain
threshold
 Anti-anxiety Drugs
Mode of Effect
Drug action
Diazepam Decrease the Decrease or
activity of remove anxiety in
limbic system patients with
mental retardation

Midazolam Decrease the Anxiolytic &

activity of causes amnesia
limbic system
 Narcotic Analgesics

Mode of Effect Side

Drug action effect
Morphine Increase Cause Resp.
pain analgesia Distres
threshold s
General Anesthetics drugs used
in Conscious Sedation
KETAMINE:- Causes:-
Dissoctative anesthesia
where a cataleptic state
can be induced.
Potent analgesic
Potential for oral use
 CONTRAINDICATI
ONS:
 Chronic obstructive pulmonary
disorder, pregnancy, myasthenia,
epilepsy, obesity, bleeding disorders.
 Uncooperative patients, unwilling,
unaccompanied.
 Dental difficulties prolonged surgery,
inadequate personnel.