Sedation: A Guide to Patient Management, 4th Edition

Abstract

This book, as described in its preface, is designed for the student of medicine or dentistry on a doctoral, postdoctoral, or continuing-education level. It provides the basic concepts needed to fully understand the drugs and techniques for all aspects of conscious sedation, deep sedation, and general anesthesia, as well as the potential complications and emergencies that may arise. This book is neither a physiology nor a pharmacology text and, as such, is designed to be used in conjunction with appropriate texts and clinical training. At times the text can appear rather wordy and repetitive. However, when one considers the audience to which it is intended, this is hardly a criticism and is usually of benefit. This softcover book is composed of 8 major sections: “Introduction;” “Spectrum of Pain and Anxiety Control;” “Oral, Rectal and Intramuscular Sedation;” “Inhalation Sedation;” “Intravenous Sedation;” “General Anesthesia;” “Emergency Preparation and Management,” and a final section titled “Special Considerations,” which discusses the pediatric, geriatric, and medically compromised patient and which involves all body systems. These major sections are further divided into 39 chapters, an appendix, and 3 addendums. The sections cover almost 600 individual topics as outlined in the index. This book relies heavily on Dr Malamed's extensive experience and insight with respect to all aspects of sedation. For example, an excellent chapter on iatrosedation illustrates this point and is often anecdotal and clearly emphasizes his comment that “an attitude of caring must become an integral part of office philosophy.” The chapters on nitrous oxide conscious sedation are particularly well illustrated and also contain a nice discussion on respiratory physiology as well as a review of the history of anesthesia and sedation and the invaluable contribution of dentistry, both past and present. To further illustrate the depth of this book, chapter 9, which discusses sublingual, transdermal, and intranasal sedation, contains an excellent description of various transdermal delivery systems. Similarly, the chapter on geriatrics is especially timely and well written. Of course, some points could be argued. For example, Dr Malamed reports that fentanyl should be used with caution in patients taking monoamine oxidase inhibitors within 14 days. This certainly applies to meperidine (Demerol). Also, the cautious use of atropine in asthma is certainly now controversial. The suggested use of Innovar for premedication would often alarm many anesthesiologists! In addition, there is no mention—however controversial—of droperidol causing prolongation of the QT interval. Similarly, many anesthesiologists could argue about the notion that isoflurane “has a pleasant odor” and “is non-irritating.” Also, from my experience, a 10- to 25-mg intravenous dose of ephedrine would generally be excessive. These are rather minor points in an otherwise excellent book that has frequently been called—and rightfully so—a “gold standard,” especially for the undergraduate dental student. Superbly illustrated, the body of the text is summarized by numerous “boxes.” Each chapter is referenced directly in the body of the text and is followed by an up-to-date list of references, which often contains classic papers and texts as well as up-to-date clinical and scientific papers. The book concludes with an index. This book clearly emphasizes proper patient evaluation, preparation, and technique regarding the conduct of every aspect of the patient's overall dental experience. It is written and illustrated in an almost step-by-step fashion. I was pleased to see the word reserve used frequently when discussing the patient's physiology, but the newer term metabolic equivalents is not used. This book should be an integral part of any education program that involves any consideration of patient management in either dentistry or medicine.