Dr Getter-Read me First

Dr Getter,
Pharmacology, Spring 2000
Oxygen Therapy

READ ME FIRST

There are four outlines of lectures Oxygen therapy, the other three are related to introducing you to the concept of conscious sedation in dentistry.

The concept of conscious sedation is that the patient is sedated but awake and responsive. The patient will react appropriately to commands and stimuli. This is to distinguish this state, conscious sedation, from the states of deep sedation and general anesthesia. Deep sedation will allow the patient to respond only to loud or strong stimuli. These responses may be inappropriate. With deep sedation there is usually respiratory and cardiovascular depression. There is also obtunding of the patients protective reflexes. General anesthesia the next level deeper than deep sedation is a state of unconsciousness which is not sleep. Here the patient can not be aroused without repeated and often painful stimuli. Here the patients protective reflexes are lost or severely obtunded. There is respiratory and cardiovascular depression. The patients airway and his respiration may have to be maintained by the anesthetist.

The concept of conscious sedation is the concept of an awake, responsive and safe patient. This patient may have an altered sensorium that can include euphoria, well being and or amnesia. This is the area that the general dentist would wish to attain for some of his patients. These patients who require some sort of help to overcome their fear and anxiety in the dental situation. It requires skill and understanding of the pharmacological agents available to achieve these goals safely. It is obvious that the level of training needed to achieve the levels of sedation and general anesthesia rise dramatically as the levels of sedation deepen.

There are legal and ethical considerations and consequences for the dentist if he tries to achieve levels of sedation for which he is not prepared or trained. The dentist must learn to operate within the boundaries of his training.

We will discuss and expose you to the drugs and techniques for general dentists to achieve safe awake conscious sedation. However nothing is absolutely safe or without risk. Therefore in many of the areas of your dental treatment you will have to make benefit verses risk assessments for the patients well being.

The best preparation for any procedure is to be prepared academically and clinically to perform the procedure. To enter into a treatment regimen inadequately prepared is a recipe for possible disaster for the patient and the dentist. Each patient must be evaulated physically and psychologicaly prior to undertaking treatment.