Role Of Dexmedetomidine In Pediatric Dental Sedation Flashcards
What is the highly selective a2 agonist receptor that is used in pedriatic dental sedative
Dexmedetomidine
Risks of administering general anesthesia
Bleeding
Edema of tongue or lips
Arrhythmias
Dislodge or dislocated endotracheal tube
IV infiltration or disconnection
Currently used sedatives in dental procedures
Midazolam
Chlorohydrate
Ketamine
Nitrous oxide
Profol
Promethazine
Hydroxyzine
Sevoflurane
Selective a2 adrenoceptor agonist
Dexmedetomidine
Mivazerol
Clonidine
A-methyldopa
Non selective a2 adrenoceptors agonist
Noradrenaline
Adrenaline
Imidazoline receptor agonist
Serial-no. 1-5
Monoxidine
Rilmenidine
Clonidine
Dexmedetomidine
Mivazerol
Imidazoline receptor binding sites have been identified in where
Brain
Pancreas
Kidneys
Is dexmedetomidine a short or long acting?
Short acting central a2 adrenoceptor agonist
It has been reported that a2-adrenoceptor agonist causes?
Sedation, anxiolysis, analgesia, sympatholytic and postoperative reduction of nausea and vomiting better than benzodiazepines.
Half life of clonidine
12.5h
How many hours does it need for clonidine to be administered before the induction o anesthesia
At least 1hr
In what year did dexmedetomidine introduced in dentistry
2005
Why is dexmedetomiine more favorable than clonidine?
Because dexmedetomidine has more favorable pharmacokinetic and shorter half-life than clonidine
Is dexmedetomidine a highly selective or non-selective drug?
It is a highly a2 selective adrenoceptor
Central effect of dexmedetomidine
Inhibits the release of norepinephrine by acting on the a2 adrenoceptors in the locus ceruleus,producing a state similar to natural sleep
Mechanism of action of dexmedetomidine
Stimulation an cessation of parasympathetic and sympathetic outflows.
Sedation is primarily induced by
Activation of post-synaptic a2 adrenergic receptors. Because dexmedetomidine attaches to the a2 receptors in the locus ceruleus and spinal cord, providing sedation and analgesia effects
Three subtypes of a2 adrenoceptors
A2A, a2B, a2C
Where can the subtypes of a2 adrenoceptors can be found
Within the blood vessels, vital organs, autonomic, peripheral and CNS
Does dexmedetomidine binds to g-protein or no?q
Yes they bind to g-protein
High affinity of a2 adrenoceptor causes what?
Bradycardia and vasodilation
Half life of dexmedetomidine
2hrs
Excretion of dexmedetomidine
95% in urine
4% in feces
Drugs that doesn’t have an affinity for GABA and opioids which does not result in respiratory depression
Midazolam, benzodiazepines, opioids and dexmedetomidine
Advantage of dexmedetomidine
- Safe sedative for children and infants
- Induce minimal respiratory depression and inhibits tachycardia
- Prevents hypoxia by maintaining the airway and enabling spontaneous respiration
- Preserves CO2 reactivity
Dexmedetomidine can be administered in?
Orally, buccally, intravenously, intranasally, intramuscularly
Simples and popular route for drug administration
Oral route
\
Buccal bioavailability and achieved its highest concentration
82%
Oral bioavailability of dexmedetomidine
16%. Because of the hepatic first pass which metabolized high amounts of dexmedetomidine
Time of onset for oral dexmedetomidine
40min before the induction of anesthesia, to attain the most favorable sedative affect
Half life of dexmedotimidine if given intravenously
6min and 2h
Administration of intranasal route in each nostril is how many ml
0.12 - 0.2 ml
Bioavailability of dexmedetomidine is ___ ad it best absorbed after __ and __ administration
82%
Sublingual and intranasal
How many doses of dexmedetomidine is given for intramuscular route ____ with a peak concentration within ___
2.5ug/kg , 15 minutes
Common adverse effect of midazolam and dexmedetomidine if given orally
Decrease BP and bradycardia
Dexmedetomidine can decrease systemic outflow by decreasing plasma epinephrine and norepinephrine levels, leading to hypotension and decreased heart rate
Suggested oral administration of dexmedetomidine
4ug/kg (adverse effects are only hypotension and bradycardfia)
Main selectve a2 adrenoceptor antagonists
Atipamezole, idazoxan, yohimbine
A2 adrenoceptors antagonist are a group of drugs capable of crossing te ____ and reversing the action of a2 adrenoceptors
Blood-brain-barrier
