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used for minimal and moderate enteral sedation in pediatric dentistry. Table 1. Common Pediatric Oral Sedation Medications Table 2. Antihistamine Adjuncts for Oral Sedation CHLORAL HYDRATE Chloral hydrate, a sedative-hypnotic aldehyde compound used in the late 1800s for insomnia, was once the predominant agent for oral sedation in children. Once absorbed by the gastrointestinal (GI) tract, chloral hydrate is metabolized by

combinations of a narcotic (eg, morphine or meperidine), a sedative-hypnotic (eg, chloral hydrate), a benzodiazepine (eg, midazolam or diazepam), and/or an antihistamine (eg, hydroxyzine HCl) ( Figure 1 ) at the following dosages: 0.66 mg/kg for morphine, 2 mg /kg for meperidine, 0.5–0.7 mg/kg for midazolam, 0.5–.7 mg/kg for diazepam, and 2 mg/kg for hydroxyzine HCl. Figure 1. Distribution of oral sedation regimens. Figure 1. Distribution of oral sedation regimens. Following the

, amnesia, analgesia, antiemetic, or antisecretory (anticholinergic). For instance, an apprehensive patient who becomes easily nauseated might very well be managed using a combination of a benzodiazepine and an antihistamine, avoiding the nauseating potential of opioids. The specific agent selected from each of these classes will depend on subtle differences the provider deems an advantage. Duration of effect, expense, and pattern of clearance are likely parameters to be considered. In order to simplify drug selection, the number of drug classes useful for the

with benzodiazepines or other nonbenzodiazepine agents discussed thus far. Its action cannot be reversed by flumazenil. THE ANTIHISTAMINES While antihistamines are primarily used to manage allergic type reactions, they also cause sedation as a side effect. The strong calming and sleep-inducing effects of Atarax, Benadryl, and Phenergan in particular, led to these medications being marketed as sedative-hypnotics in addition to some of their other effects in preventing nausea, vomiting, and the adverse sequelae of allergic reactions

combination of sedation medications can help the clinician complete treatment, but brings increased risk of adverse events such as respiratory depression. 8 Antihistamines are a popular class of sedative, generally used in combination with other sedatives or opioids, with desired effects of sedation, hypnosis, and nausea prevention, while having the advantage of not causing unconsciousness, respiratory depression, or cardiac depression like other sedation medications. 9 Hydroxyzine and promethazine are the most commonly used agents in pediatric dental practice. When used

traditional agents. 9 , 10 Dental Implications for Patients Medicated with Antipsychotic Drugs There are no well-established drug interactions associated with antipsychotic medications and drugs conventionally used in dental practice. However, some consideration may be given to the use of vasopressors in local anesthetic solutions and the use of antihistamines and antiemetics used in sedation regimens. Most antipsychotic agents have modest alpha-blocking actions that may counter any increase in systemic vascular resistance following

palpated and her SpO 2 dropped to 75%. Two doses of flumazenil (0.3 and 0.2 mg) were administered at which point blood pressure and pulse could not be assessed. Tachycardia was observed on the monitor, but no wheezing or stridor was evident. Norepinephrine (8 mcg/min) and epinephrine (1 mg) were administered, and the patient's pulse rate was then measured at 130 bpm. She developed a generalized rash all over her body at which point dexamethasone (5 mg) and an antihistamine were administered and symptoms resolved. Subsequently, arterial blood gas analysis and chemical

initial step in establishing the existence of rare adverse events. For example, anesthesiologists use protocols to prevent and treat malignant hyperthermia, an unknown phenomena prior to 1960. The case report by Denborough et al published in 1962 alerted anesthesiologists to the familial relationship of this rare and misunderstood life-ending event. 5 Only after publication of this case report was the puzzle of malignant hyperthermia and its etiology revealed. Approved by the FDA in 1985, terfenadine (Seldane) was the first prescription antihistamine

should occur within minutes. If necessary, this dose can be repeated twice more in 5-minute intervals. Systolic blood pressures below 90 mmHg contraindicate the use of this drug. 4. Injectable Antihistamine An antihistamine is indicated for the management of allergic reactions. Whereas mild non-life threatening allergic reactions may be managed by oral administration, life-threatening reactions necessitate parenteral administration. Two injectable agents may be considered, either diphenhydramine or chlorpheniramine. They

still an added antioxidant in all solutions containing epinephrine or levonordefrin. 9 Patients with true local anesthetic allergies have been treated in the past with the use of antihistamines as a local anesthetic. Their use was initially described in 1939 by Rosenthal and Minard. 10 Diphenhydramine's (DPH's) anesthetic properties are thought to be due to its similar structure to other neural blocking agents. 11 DPH contains an aromatic ring, an intermediate chain, and an amino terminus in its molecular structure. Figure 1 compares the structures of