Pediatric Sedation in the Dental Office

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Course Content

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Lessons Status

1

Preoperative assessment

Objectives

Appropriate case selection

Patient medical history

ASA classification system – 1

ASA classification system -2

Medical history

Medical consultations – 1

Medical consultations – 2

NPO guidelines

Patient responsibilities

Patient responsibilities – 2

Surgical considerations

Conclusion

2

Physical evaluation and medical history

Introduction

Outline

Focusing on the airway

Obesity – 1

Obesity – 2

Obesity obstruction example

Obesity – 3

Obesity – 4

Obesity – 5

Pharmacologic considerations for obese patients

Postoperative care – 1

Postoperative care – 2

Limited neck mobility – Introduction

Limited neck mobility – 1

Limited neck mobility – 2

Limited neck mobility – 3

Micrognathia and retrognathia

Definitions

Micrognathia and retrognathia – 1

Micrognathia and retrognathia – 2

Tonsillar obstruction

Introduction

Tonsillar obstruction – 1

Tonsillar obstruction – 2

Tonsillar obstruction – 3

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3

Anatomic and physiologic differences between pediatric and adult patients

Overview

Airway anatomy

Peds vs adult airway

Pediatric intubation

Developmental differences – 1

Developmental differences – 2

Developmental differences – 3

Developmental differences – 4

Developmental differences – 5

Developmental differences – 6

Developmental differences – 7

Fluid management

Fluid management table

Summary

4

Pediatric respiratory assessment

Overview

Subjective analysis – 1

Subjective analysis – 2

Objective analysis

Facial features

Mallampati

Mallampati – illustration

Brodsky

BMI

BMI – table

Physical examination

Auscultation

Auscultation table

Auscultation sounds – normal

Auscultation – crackles

Auscultation – ronchi

Auscultation – stridor

Auscultation sounds – Wheezing

Asthma

URI algorithm

5

Informed consent

Definitions

"Informed"

"Consent"

Historical context

What must be disclosed?

Texas disclosure requirements

List B

List A

List A – general anesthesia

List A – deep sedation

List A – prenatal/early childhood anesthesia

Not in list A or B

Anesthesia consent form

Presumptions

Who may consent?

When should consent occur?

Who may obtain the consent?

6

Pharmacology

Pharmacokinetics

Pharmacodynamics

Pharmacokinetics – stages

Absorption

Factors affecting absorption

Enteral vs. Parenteral

Route of administration

First pass effect

Hepatic extraction rates

Membranes – 1

Membranes – 2

Drug distribution

Tissue types

Vessel rich group

Muscle group

Fat group

Vessel poor group

Volume of distribution

Volume of distribution – 2

Redistribution

Drug elimination and clearance

Metabolism

CYP substrates

Hepatic clearance

Hepatic extraction ratios

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7

Anesthesia technique

Introduction

Keeping it safe

Preparing for a sedation

NPO Requirements

Depth of anesthesia

Commonly used medications

Diazepam

Lorazepam

Midazolam

Triazolam

Hydroxyzine

Promethazine

Diphenhydramine

Meperidine – 1

Meperidine – 2

Chloral Hydrate

Nitrous Oxide

Reversal agents

8

Anesthesia monitoring and record keeping

Introduction

Objectives

Why do we monitor?

ASA monitors

Rules and regulations – 1

Rules and regulations – 2

Rules and regulations – 3

Pulse oximetry – 1

Pulse oximetry – 2

Pulse oximetry – 3

Pulse oximetry – 4

Precordial stethoscope

Capnography – 1

Capnography – 2

Electrocardiography – 1

Electrocardiography – 2

Electrocardiography – 3

Electrocardiography – 4

Electrocardiography – 5

Blood pressure – 1

Blood pressure – 2

Blood pressure – 3

Temperature

Anesthesia record

Anesthesia record – example

9

Emergency management of pediatric patients

Introduction

Critical thinking – 1

Critical thinking – 2

Critical thinking – 3

Critical thinking – 4

Non-technical skills

Team resource management

CRM – 1

Components of CRM

Cognitive aids

Cognitive aids – resources

Airway

Equipment

Regulators

Quick connects

Bag valve mask

Bag – mouth ventilation masks

Using the mask to ventilate

Syringes

IV fluids

Intra osseous (IO)

Oral pharyngeal airways

Nasal pharyngeal airways

Laryngeal mask airway (LMA)

Endotracheal tubes (ETTs)

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10

Anesthesia and sedation technique

Anesthetic technique for oral sedation

Pros and Cons

Recommendations

NPO

Setting up for a procedure under sedation

Depth of anesthesia

Commonly used medications

Diazepam

Lorazepam

Midazolam

Triazolam

Hydroxyzine

Promethazine

Diphenhydramine

Meperidine

Chloral Hydrate

Nitrous Oxide

Reversal agents

Completing the procedure

11

Patient recovery and discharge

Introduction

Objectives

Objectives – 2

Factors which may affect the recovery period

Anesthetic factors

Minimal Sedation

Moderate sedation

Deep sedation

General anesthesia

Levels of anesthesia – ADA

Levels of anesthesia – ASA definitions

ASA classifications

Surgical factors

Surgical risk

Airway factors

Assessment

Phases of recovery

Phases of recovery – 2

Early (Phase 1)

Intermediate (Phase 2)

Late (Phase 3)

Phase 1

Phase 1 diagram

Respiratory function

Cardiovascular function

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