RESUMO
Offices and outpatient dental facilities must be properly equipped with devices for airway management, oxygenation, and ventilation. Optimizing patient safety using crisis resource management involves the entire dental office team being familiar with airway rescue equipment. Basic equipment for oxygenation, ventilation, and airway management is mandated in the majority of U.S. dental offices, per state regulations. The immediate availability of this equipment is especially important during the administration of sedation and anesthesia, as well as the treatment of medical urgencies/emergencies. This article reviews basic equipment and devices essential in any dental practice, whether providing local anesthesia alone or in combination with procedural sedation.
RESUMO
The risk for complications while providing dental procedures is greatest when caring for patients having significant medical compromise. It is comforting that significant adverse events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, the office team must be prepared to manage untoward events should they arise. This continuing education article will address basic emergency drugs that should be available in all dental practices and additional agents that become essential for those practices providing various levels of procedural sedation or general anesthesia.
Assuntos
Assistência Odontológica , Emergências , Tratamento de Emergência , Preparações Farmacêuticas , Agonistas alfa-Adrenérgicos/uso terapêutico , Anafilaxia/tratamento farmacológico , Anestesia Dentária , Anestesia Geral , Angina Pectoris/tratamento farmacológico , Antiarrítmicos/uso terapêutico , Antiasmáticos/uso terapêutico , Antídotos/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Broncodilatadores/uso terapêutico , Consultórios Odontológicos , Tratamento de Emergência/instrumentação , Tratamento de Emergência/métodos , Epinefrina/uso terapêutico , Antagonistas de Receptores de GABA-A/uso terapêutico , Parada Cardíaca/tratamento farmacológico , Humanos , Hipersensibilidade/tratamento farmacológico , Hipoglicemia/tratamento farmacológico , Hipotensão/tratamento farmacológico , Antagonistas de Entorpecentes/uso terapêutico , Vasodilatadores/uso terapêuticoRESUMO
Offices and outpatient dental facilities must be properly equipped with devices for airway management, oxygenation, and ventilation. Optimizing patient safety using crisis resource management (CRM) involves the entire dental office team being familiar with airway rescue equipment. Basic equipment for oxygenation, ventilation, and airway management is mandated in the majority of US dental offices per state regulations. The immediate availability of this equipment is especially important during the administration of sedation and anesthesia as well as the treatment of medical urgencies/emergencies. This article reviews basic equipment and devices essential in any dental practice whether providing local anesthesia alone or in combination with procedural sedation. Part 2 of this series will address advanced airway devices, including supraglottic airways and armamentarium for tracheal intubation and invasive airway procedures.
Assuntos
Manuseio das Vias Aéreas/instrumentação , Oxigenoterapia/instrumentação , Ventiladores Mecânicos , Anestesia Dentária , Anestesia Local , Cateterismo/instrumentação , Sedação Consciente , Clínicas Odontológicas , Consultórios Odontológicos , Humanos , Intubação/instrumentação , Máscaras , Nasofaringe , Orofaringe , Segurança do Paciente , Respiração com Pressão Positiva/instrumentaçãoRESUMO
Adverse reactions may occur with any of the medications prescribed or administered in dental practice. Most of these reactions are somewhat predictable based on the pharmacodynamic properties of the drug. Others, such as allergic and pseudoallergic reactions, are less common and unrelated to normal drug action. This article will review the most common adverse reactions that are unrelated to drug allergy.
Assuntos
Assistência Odontológica , Preparações Farmacêuticas Odontológicas/efeitos adversos , Analgésicos/efeitos adversos , Anestésicos Gerais/efeitos adversos , Anestésicos Locais/efeitos adversos , Antibacterianos/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversosRESUMO
Antibiotics play a vital role in dental practice for managing orofacial infections. They are used to manage existing infection and they are also used as prophylaxis for certain medical conditions and surgical procedures. This article will review pharmacological and therapeutic considerations for the proper use of these agents for dental infections.
Assuntos
Antibacterianos , Preparações Farmacêuticas Odontológicas , Antibacterianos/efeitos adversos , Antibacterianos/classificação , Antibacterianos/farmacologia , Antibioticoprofilaxia/estatística & dados numéricos , Antifúngicos/farmacologia , Interações Medicamentosas , Endocardite Bacteriana/prevenção & controle , HumanosRESUMO
Appropriate preoperative assessment of the dental patient should always include an analysis of the patient's medications. This article reviews the actions and indications for the various categories of antithrombotic medications and considers actual risks for postoperative bleeding and potential interactions with drugs the dental provider might administer or prescribe.
Assuntos
Assistência Odontológica , Fibrinolíticos/farmacologia , Anticoagulantes/farmacologia , Fibrinolíticos/uso terapêutico , Humanos , Inibidores da Agregação Plaquetária/farmacologia , Fatores de RiscoRESUMO
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.
Assuntos
Anti-Inflamatórios/farmacologia , Glucocorticoides/farmacologia , Anti-Inflamatórios/uso terapêutico , Antieméticos/farmacologia , Antieméticos/uso terapêutico , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Preparações Farmacêuticas Odontológicas/farmacologia , Preparações Farmacêuticas Odontológicas/uso terapêuticoRESUMO
Adverse reactions to medications prescribed or administered in dental practice can be worrying. Most of these reactions are somewhat predictable based on the pharmacodynamic properties of the drug. Others, such as allergic and pseudoallergic reactions, are generally unpredictable and unrelated to normal drug action. This article will review immune and nonimmune-mediated mechanisms that account for allergic and related reactions to the particular drug classes commonly used in dentistry. The appropriate management of these reactions will also be addressed.
Assuntos
Anestesia Geral/efeitos adversos , Anestésicos Locais/efeitos adversos , Hipersensibilidade a Drogas , Preparações Farmacêuticas Odontológicas/efeitos adversos , Adolescente , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Anafilaxia/tratamento farmacológico , Anti-Inflamatórios não Esteroides/efeitos adversos , Dióxido de Carbono/sangue , Cefalosporinas/efeitos adversos , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/metabolismo , Hipersensibilidade a Drogas/patologia , Feminino , Humanos , Laringoscopia/instrumentação , Hipersensibilidade ao Látex , Masculino , Pessoa de Meia-Idade , Penicilinas/efeitos adversos , Adulto JovemRESUMO
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.
Assuntos
Fármacos do Sistema Nervoso Autônomo/farmacologia , Agonistas Adrenérgicos/farmacologia , Antagonistas Adrenérgicos/farmacologia , Albuterol/farmacologia , Sistema Nervoso Autônomo/fisiologia , Colinérgicos/farmacologia , Antagonistas Colinérgicos/farmacologia , Efedrina/farmacologia , Humanos , Fenilefrina/farmacologiaRESUMO
Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. Their use is so routine, and adverse effects are so infrequent, that providers may understandably overlook many of their pharmacotherapeutic principles. The purpose of this continuing education article is to provide a review and update of essential pharmacology for the various local anesthetic formulations in current use. Technical considerations will be addressed in a subsequent article.
Assuntos
Anestésicos Locais/farmacologia , Antagonistas Adrenérgicos alfa/farmacologia , Período de Recuperação da Anestesia , Anestesia Dentária/métodos , Anestesia Local , Anestésicos Locais/química , Anestésicos Locais/toxicidade , Carticaína/farmacologia , Hipersensibilidade a Drogas , Interações Medicamentosas , Humanos , Lidocaína/farmacologia , Dose Máxima Tolerável , Fentolamina/farmacologia , Vasoconstritores/farmacologiaRESUMO
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.
Assuntos
Sedação Consciente/métodos , Sedação Profunda/métodos , Hipnóticos e Sedativos/farmacologia , Analgésicos Opioides/farmacologia , Anestesia Geral/classificação , Benzodiazepinas/farmacologia , Sedação Consciente/classificação , Sedação Profunda/classificação , Humanos , Hipnóticos e Sedativos/classificação , Óxido Nitroso/farmacologiaRESUMO
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.
Assuntos
Anestesia Dentária/métodos , Sedação Consciente , Sedação Profunda , Hipnóticos e Sedativos/farmacocinética , Absorção , Disponibilidade Biológica , Encéfalo/metabolismo , Vias de Administração de Medicamentos , Meia-Vida , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/sangue , Hipnóticos e Sedativos/urina , Infusões Intravenosas , Distribuição TecidualRESUMO
The risk for cardiovascular complications while providing any level of sedation or general anesthesia is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, providers must be prepared to manage untoward events should they arise. This continuing education article will review cardiovascular complications and address their appropriate management.
Assuntos
Doenças Cardiovasculares/etiologia , Sedação Consciente/efeitos adversos , Sedação Profunda/efeitos adversos , Angina Pectoris/etiologia , Arritmias Cardíacas/etiologia , Reanimação Cardiopulmonar , Doenças Cardiovasculares/tratamento farmacológico , Tratamento de Emergência , Humanos , Hipertensão/etiologia , Hipotensão/etiologia , Infarto do Miocárdio/etiologia , Síncope Vasovagal/etiologiaRESUMO
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.
Assuntos
Manuseio das Vias Aéreas/métodos , Sedação Consciente/efeitos adversos , Sedação Profunda/efeitos adversos , Tratamento de Emergência/métodos , Oxigênio/administração & dosagem , Insuficiência Respiratória/terapia , Manuseio das Vias Aéreas/instrumentação , Obstrução das Vias Respiratórias/terapia , Cartilagem Cricoide/cirurgia , Humanos , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Respiração com Pressão Positiva/instrumentação , Náusea e Vômito Pós-Operatórios/terapia , Insuficiência Respiratória/etiologia , TraqueotomiaRESUMO
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.
Assuntos
Preparações Farmacêuticas Odontológicas/efeitos adversos , Analgésicos/efeitos adversos , Anestésicos Locais/efeitos adversos , Anti-Infecciosos/efeitos adversos , Interações Medicamentosas , Humanos , Hipnóticos e Sedativos/efeitos adversos , Vasoconstritores/efeitos adversosRESUMO
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.
Assuntos
Antieméticos/uso terapêutico , Soluço/fisiopatologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Náusea e Vômito Pós-Operatórios/fisiopatologia , Terapia por Acupuntura , Analgésicos Opioides/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Ansiedade/complicações , Antagonistas de Dopamina/uso terapêutico , Soluço/etiologia , Soluço/prevenção & controle , Humanos , Antagonistas dos Receptores de Neurocinina-1 , Posicionamento do Paciente , Pneumonia Aspirativa/prevenção & controle , Náusea e Vômito Pós-Operatórios/etiologia , Antagonistas da Serotonina/uso terapêutico , Fatores SexuaisRESUMO
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.
Assuntos
Analgésicos/farmacologia , Dor Pós-Operatória/tratamento farmacológico , Odontalgia/tratamento farmacológico , Acetaminofen/administração & dosagem , Acetaminofen/farmacologia , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/farmacologia , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/farmacologia , HumanosRESUMO
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.
Assuntos
Anestesia Dentária/métodos , Anestesia Geral/efeitos adversos , Regulação da Temperatura Corporal/efeitos dos fármacos , Regulação da Temperatura Corporal/fisiologia , Sedação Consciente/efeitos adversos , Anestesia Dentária/efeitos adversos , Anestésicos/efeitos adversos , Humanos , Hipotálamo/fisiologia , Hipotermia/induzido quimicamente , Hipotermia/prevenção & controle , Hipertermia Maligna/etiologia , Sensação Térmica/efeitos dos fármacos , Sensação Térmica/fisiologiaRESUMO
A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to provide sedation or general anesthesia as an adjunct to dental treatment. This article, the second of a 2-part sequence on preoperative assessment, will address pulmonary and other noncardiovascular disorders.