Clinical Sedation in Dentistry potx

[...]... functioning of the VMC A decrease in CO2 leads to 9781405180696_4_002 11/28/08 1:48 PM Page 23 Applied anatomy and physiology decreased VMC activity and a fall in BP, with an increase in CO2 having the opposite effect • Sensory nerves: Pain modifies the activity of the VMC, with mild pain increasing VMC activity, leading to an increase in BP Severe pain decreases VMC activity and may lead to a drop in BP In. .. pressure receptors found in the aortic arch and carotid sinus Increased baroreceptor activity inhibits vasomotor centre (VMC) activity in the brain, leading to arterial vasodilatation, a lowering in PR and a consequent fall in BP Similarly, decreased baroreceptor activity disinhibits VMC activity leading to arterial vasoconstriction, a rise in PR, with a corresponding rise in BP Receptors can also... principles of its practice SEDATION In addition to the history and development of conscious sedation, this section also presents the definition and guidelines for sedation in dental practice 9781405180696_4_001 11/28/08 1:46 PM Page 11 Spectrum of anxiety management History of sedation It is difficult to pinpoint the historical beginnings of sedation The use of alcohol as a narcoleptic is mentioned in. .. sedation in dentistry in the UK is regulated by the General Dental Council (GDC) and the Department of Health (DH) Recent guidance applicable to the UK includes A Conscious Decision published by the DH in 2000 In 2001 the GDC acted to strengthen the standards relating to conscious sedation in their professional regulations Maintaining Standards More recently two further guidance documents, relating specifically... conscious sedation, not just in dentistry but in many other areas of surgery As with the history of anaesthesia, dentistry has taken the opportunity to lead the way and to point to the ongoing possibilities of further development This must be based on a sound understanding of the principles and practice of safe sedation, and the remainder of this book aims to give such grounding Definition of conscious sedation. .. sedation is essential to establish a basis for safe clinical practice Sound clinical practice must be based on a solid foundation of basic medical science and the following sections address the relevant anatomy, physiology and general pharmacokinetics of sedation (Pharmacology of the individual agents used for sedation is found in Chapter 4) All sedatives produce their effects by acting on the brain... and vein A, Artery, lined with nucleated endothelium (e) Underneath the endothelium is the elastic lamina muscle layer (m) The muscle layer is surrounded by connective tissue fibres, the adventitia (a) V, Vein, has thin endothelial lining (e), under which is a very thin muscle layer (m) The adventia (a) is similar to the artery 9781405180696_4_002 11/28/08 18 1:48 PM Page 18 Clinical Sedation in Dentistry. .. 1:48 PM Page 22 Clinical Sedation in Dentistry as it maintains blood flow to and from the heart, the brain, kidneys and other major organs and tissues The systolic pressure is defined as the peak pressure in the arteries, which occurs near the beginning of the cardiac cycle The diastolic pressure is the lowest pressure (at the resting phase of the cardiac cycle) Typical values for a resting, healthy adult... was due in no small part to the synthesis of a class of drugs now widely known as the benzodiazepines The first of these, chlordiazepoxide, was synthesised in 1956 but it was the introduction of diazepam, 11 9781405180696_4_001 12 11/28/08 1:46 PM Page 12 Clinical Sedation in Dentistry Valium®, in both oral and parenteral forms which heralded the arrival of safe sedation Continued development of sedation. .. conscious sedation in dental practice The Poswillo report made over 50 recommendations aimed at reducing the risk of adverse health effects or death during dental treatment, including treatment under sedation and general anaesthesia The recommendations included standards for sedation and general anaesthesia practice; emergency equipment and drugs; training and inspection and registration of premises Within . 11/28/08 1:47 PM Page iv Clinical Sedation in Dentistry 9781405180696_1_pretoc 11/28/08 1:47 PM Page i 9781405180696_1_pretoc 11/28/08 1:47 PM Page ii Clinical Sedation in Dentistry Written by Professor. Pharmacology of inhalation and intravenous sedation 57 5. Premedication and oral sedation 77 6. Principles and practice of inhalation sedation 81 7. Principles and practice of intravenous sedation. development of conscious sedation in dentistry, introducing the reader to the history and main principles of its practice. SEDATION In addition to the history and development of conscious sedation, this