Glucocorticosteroids are a product of the adrenal cortex and perform a staggering number of physiological effects essential for life. Their clinical use is largely predicated on their anti-inflammatory and immunosuppressive properties, but they also have notable efficacy in the prophylaxis of postoperative nausea and vomiting. This article reviews the basic functions of glucocorticoids and their clinical use in dental practice.
Glucocorticosteroid; Trauma; Postoperative swelling; PONV; Dentistry; Mucosal lesions
Autonomic drugs are used clinically to either imitate or inhibit the normal functions of the sympathetic and parasympathetic nervous systems. A large number of additional drug classes also interact with these systems to produce a stunning number of possible side effects. This article reviews the basic function of the autonomic nervous system and the various drug classes that act within these neural synapses.
Autonomic drugs; Sympathomimetics; Adrenergic agonists; Adrenergic antagonists; Cholinergic drugs; Anticholinergic drugs
Moderate and deep sedation can be provided using various classes of drugs, each having unique mechanisms of action. While drugs within a given classification share similar mechanisms and effects, certain classes demonstrate superior efficacy but added concern regarding safety. This continuing education article will highlight essential principles of pharmacodynamics and apply these to drugs commonly used to produce moderate and deep sedation.
Pharmacodynamics; Drug actions; Drug mechanisms; Sedation
Moderate and deep sedation can be provided using several routes of drug administration including oral (PO), inhalation, and parental injection. The safety and efficacy of these various techniques is largely dependent on pharmacokinetic principles. This continuing education article will highlight essential principles of absorption, distribution, and elimination of commonly used sedative agents.
Pharmacokinetics; Drug administration; Sedation
The risk for complications while providing any level of sedation or general anesthesia is greatest when caring for patients having significant medical compromise. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, we must be prepared to manage untoward events should they arise. This continuing education article will review respiratory considerations and will be followed by a subsequent article addressing cardiovascular considerations.
Medical emergencies; Sedation; Anesthesia; Complications
The potential for interactions with current medications should always be considered when administering or prescribing any drug. Considering the staggering number of drugs patients may be taking, this task can be daunting. Fortunately, drug classes employed in dental practice are relatively few in number and therapy is generally brief in duration. While this reduces the volume of potential interactions, there are still a significant number to be considered. This article will review basic principles of drug interactions and highlight those of greatest concern in dental practice.
Drug interactions; CYP450; Drug potentiation; Drug synergism
Nausea, vomiting, and hiccups are troubling complications associated with sedation and general anesthesia. This article will review the basic pathophysiology of these events and current recommendations for their prevention and management.
Nausea; Vomiting; PONV; Hiccups; Anesthetic complications; Antiemetics
Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series.
Pain management; Analgesics; Postoperative pain; Dental pain
Mild hypothermia is common during deep sedation or general anesthesia and is frequently associated with patient discomfort and shivering. Greater declines in temperature can produce an even greater number of significant detrimental effects. This article reviews principles of thermoregulation and influences of anesthetic agents. An understanding of these will provide a foundation for strategies to reduce heat loss and better manage patient discomfort when it occurs.
Sedation; General anesthesia; Thermoregulation; Hypothermia; Shivering
Cardiovascular emergencies represent the most feared complications in dental practice. Not only do they present the greatest possibility for morbidity and mortality, but their pathogenesis and treatment are poorly understood. This article reviews fundamental physiologic and pathological concepts that will guide the clinician toward a more cognitive approach to patient assessment and management. The treatment algorithms presented develop rationally from these fundamental scientific principles.
Preoperative sedation is a vital component of general dental practice. The final goal and supporting objectives for training programs have been developed. An emphasis must now be placed on effective methods for accomplishing this goal. The design found in the American Heart Association's ACLS training program may serve as an excellent model for future curriculum development.