EMERGENCY PREPARATION AND MANAGEMENT
Whenever drugs are administered or prescribed, adverse reactions may occur. Fortunately, with the vast majority of drugs currently used in the management of pain and anxiety, the incidence of adverse drug reactions (ADRs) is low. Indeed, those drugs that, although therapeutically useful, have a greater incidence of ADRs are rapidly replaced in the physician’s and dentist’s armamentarium by newer, equally useful drugs possessing a decreased risk of ADRs. The barbiturates are an example of such a group.
Indiscriminate drug usage is one of the major causes of the increase in the number of serious incidents of drug-related life-threatening emergencies that are reported in the medical and dental literature.1,2 It is hoped that whenever a drug is administered or prescribed, a rational purpose exists for its administration. Most drug-related emergency situations are classified as one aspect of iatrogenic disease, a category encompassing a spectrum of adverse effects produced unintentionally by health care providers in the course of patient management.
The frequency of occurrence of ADRs as reported in the medical and dental literature has ranged from 3% to 20% of all hospital admissions.1–4 Of patients hospitalized for other reasons, 5% to 40% will experience an ADR during their hospitalization. Furthermore, another 10% to 18% of those patients hospitalized because of an ADR will have yet another ADR while in the hospital, which results in increased length of hospitalization.4 Additionally, more than 100,000 patients die each year as a result of ADRs while hospitalized (in U.S. hospitals).5
Because the overwhelming majority of drugs discussed in this text are CNS depressants administered to patients for the purpose of managing their treatment-related fears and anxieties, it is likely that ADRs will be noted at some time. For this reason, the dentist and the entire office staff must be able to recognize and be prepared to manage these situations rapidly and effectively.
This section is divided into three chapters. The first two chapters discuss the subject of preparation: of the office, office personnel, and the requirement for emergency drugs and equipment. The third chapter reviews the management of systemic emergencies that might arise during sedation procedures. Localized complications have been reviewed with each of the major techniques of sedation (see Chapter 10 for intramuscular sedation, Chapter 16 for inhalation sedation, and Chapter 27 for intravenous sedation).