Hartford, Connecticut, December 10, 1844 … Over 160 years ago Samuel Cooley, a clerk in a retail store, ran around a stage in an intoxicated state, little realizing the major role he was playing in forever altering the degree of pain and suffering that patients throughout the world would experience during surgery.
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Cooley had come to attend a popular science lecture in which advances in science were demonstrated. One demonstration was of the intoxicating effects of “laughing gas,” which Cooley volunteered to inhale. Also in attendance that fateful evening was Horace Wells, a local dentist who, on seeing Cooley injure his leg but continue to run about as though nothing had happened, considered there might be a clinical application for this “laughing gas.” On the following day, December 11, 1844, nitrous oxide (“laughing gas”) was administered to Dr. Horace Wells, rendering him unconscious and able to have a wisdom tooth extracted without any awareness of pain.
The world had forever been changed. But had it? “In 1845 the New York Daily Tribune published a detailed account of an amputation. The operation took place at New York Hospital, a five-acre nest of low brick buildings, located on what is now Lower Broadway.The patient was a young man, cradled tenderly the whole time by his father and at the same time held firmly—and brusquely—in place by the attendants. As the surgeons—there were two—made their cuts, the boy’s screams were so full of misery that everyone who could left the room. The first part of the operation complete, the young man watched ‘with glazed agony’ as the chief surgeon pushed a saw past the sliced muscles, still twitching, and listened as the blade cut through the bone in three heavy passes, back and forth. That was the only noise in the room, for the boy had stopped screaming.”1 One hundred and sixty years after the discovery of anesthesia so much is taken for granted.
Local anesthetics are administered to patients when a surgical procedure might be ever so slightly painful. Yet in 1844 these drugs did not exist. When patients require treatment, a variety of techniques are available to help manage their fears—intravenous sedation; intramuscular sedation; oral, rectal, transmucosal, and intranasal sedation; and general anesthesia. These routes and techniques of drug administration were not available in 1844. No longer does a patient about to undergo dental or surgical procedures face that prospect with utter hopelessness and despair. Dentistry has long recognized that many persons are frightened of the dental experience and, to its credit, has taken steps to prepare the dental profession to recognize and manage these patients. In its approach to the management of pain and Preface anxiety, the dental profession has remained in the forefront of all the health-care professions. Publication of the Guidelines for the Teaching of Pain and Anxiety Control and the Management of Related Complications (ADA, 1979) put forth a cohesive document aimed at providing well-constructed standards for teaching the future generations of dental students and dentists safe and effective techniques of managing pain and anxiety. A dentist graduating from a dental school in the United States in the past 30 years has received training (albeit to varying degrees of clinical proficiency) in these important areas. For phobic patients seeking dentists able to manage their dental fears, the search is usually short. More and more dentists promote their ability and desire to “cater to cowards.” The public has been the ultimate beneficiary of that chance encounter between Mr. Samuel Cooley and Dr. Horace Wells in December 1844. This Fifth Edition of Sedation: A Guide to Patient Management is, as were its predecessors, designed for the student of medicine or dentistry on a doctoral, postdoctoral, or continuing dental education level. It is meant to be comprehensive, providing basic concepts needed to fully understand the drugs and techniques and how they work, step-by-step descriptions of the various techniques, and a look at the potential complications and emergencies that might arise. More than anything else, this edition of Sedation is designed to be used in conjunction with a course in sedation that provides for the clinical management of patients in a controlled (supervised) environment. Only through this type of program can the techniques described in this book be used safely and effectively in a dental or medical practice.
Free Online Books Download: Sedation A Guide to Patient Management 5th Edition PDF