This paper aims to review the existing literature on the pharmacology of a number of sedative drugs used in the management of dental anxiety in the conscious child patient. Pharmacological agents may be used as a complement to behavioural techniques to assist in the management of anxiety in some paediatric dental patients. Their use may also be especially indicated in children with disabilities. These agents are usually sedative in action and do not, in themselves, eliminate anxiety but merely enhance patient acceptance by reducing arousal and modifying anticipation of danger. The agents used are varied and diverse and include nitrous oxide, benzodiazepines and narcotics. Nitrous oxide has proved to be of particular value but carries a degree of risk for the operating staff. Amongst the benzodiazepines, Midazolam has been used more frequently in recent years. It may be given by a variety of routes, including intra-nasally. Dentists who employ sedative agents and techniques should be familiar with the pharmacology of the agents selected, be cognisant of the risks and benefits of the technique employed and be able to manage any adverse events that may arise through their use.
Background: Trauma remains a leading cause of morbidity and mortality in resource challenged economies. In Nigeria, the number of deaths due to trauma-induced injuries is on the rise. Major trauma victims are usually admitted into the intensive care unit in our hospital. The aim of this study is to assess the outcome of the trauma cases admitted to the ICU. Methods: We performed an eight-year retrospective review of all trauma admissions into our multidisciplinary six bed intensive care unit (ICU) to assess the impact of trauma on the ICU. Data collected was processed using the Statistical Packages for the Social Scientists 16.0. Results: Three hundred and seventy two cases (372) cases of major trauma were admitted during the study period, representing 41.6% of the total ICU admissions. The male to female ratio was 2.3:1, while the mean age of the trauma patients was 32.8 yrs compared to 37.0 yrs for non-trauma cases. Trauma admissions were almost exclusively emergencies (93.8%) with a mean ICU length of stay of 7.7 ± 8.1 days. Survivors had a statistically significant longer length of stay (LOS) than non-survivors (11.6 ± 9.8 vs. 4.2 ± 3.9 days [p = 0.0001]). Mortality rate of trauma patients was significantly higher than that of all ICU admissions (53.2% vs. 37.9%, p = 0.0001). Road traffic crashes were responsible for most deaths (68.6%) followed by burn injuries (29.9%). Conclusion: Trauma is a leading cause of intensive care utilization in our hospital,. Management strategy should include increased public enlightenment campaign, enforcement of safety rules and improved pre-and in-hospital care of trauma victims.
Our data suggest that PRO sedation is safe when used for outpatient diagnostic colonoscopy in low-resource settings with better patients and physician satisfaction. The synergistic sedative effect of midazolam and/or opioids combined with PRO help reducing the dose of PRO used with better recovery.
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