ABSTRACT
Pain management is important when dealing with pediatric dental patients. The use of local anesthetics can be especially challenging for children taking psychotropic medications. The purpose of this paper was to identify pertinent information regarding drug interactions between vasoconstrictor/local anesthetic combinations and medications for the management of psychiatric or behavior disorders in children. Many of the reported interactions are controversial, largely theoretical with very limited clinical evidence, and not well defined. However, when considering the potential for significant increased blood pressure when local anesthesia containing a vasoconstrictor is used, a thorough under standing of the pharmacological actions of medications used to treat psychiatric or behavioral disorders and vasoconstrictors can help dental professionals minimize the potential risk of drug interactions in their practice.
Subject(s)
Anesthesia, Dental , Anesthesia, Local , Anesthetics, Local/administration & dosage , Psychotropic Drugs/therapeutic use , Vasoconstrictor Agents/therapeutic use , Anesthetics, Local/adverse effects , Child , Child Behavior Disorders/drug therapy , Drug Interactions , Humans , Neurotransmitter Agents/adverse effects , Neurotransmitter Agents/therapeutic use , Psychomotor Disorders/drug therapy , Psychotropic Drugs/adverse effects , Vasoconstrictor Agents/adverse effectsABSTRACT
Patients have rated severe nausea to be worse than postoperative pain. The overall incidence of postoperative nausea and vomiting (PONV) is 25%-30% and can lead to delayed discharge and unanticipated hospital admission. After outpatient surgery, the overall incidence of postdischarge nausea has been reported to be 17% and of vomiting 8%, higher than nausea and vomiting reported during the procedure or recovery. Patients who experienced postdischarge nausea and vomiting (PDNV) were unable to resume normal daily activities as quickly. This paper addresses the frequency, pathophysiology and patient perception of PONV and PDNV and reviews antiemetics and adjunctive medications used for the prevention, management, and treatment of PONV and PDNV. For each, the indication, mechanism of action, adverse effects, drug interactions, and implications for oral surgery and outpatient sedation are provided. Because many antiemetics are available for prevention, management, and treatment of PONV and PDNV, optimal medication choices are important for each procedure and patient.