Psychological Effects
of
ConsciolS Sedation
Robert Minnis D.D.S.
The most profound changes that take place under N20/02 sedation are psychological in nature. The term "euphoria" is often used to "explain" the expanded sense of well being brought about under analgesia. Time distortion is mentioned as a side effect of the deeper stages of nitrous sedation. Some literature in the past has referred to the "high" feeling induced by N20/02. These attempts to explain what occurs when a person experiences conscious sedation are only small pieces of a very elaborate and complex profile which is beginning to unfold due to recent findings in the neurosciences. To best appreciate the psychological changes that occur tinder N20/02, one might experience those changes. However, this approach most often leaves one at a loss for language to describe the state; it can be an ineffable, inexplicable feeling. There is so much that occurs within the spectrum of our consciousness that does not lend itself to expression in words. A conscious "journey" into that realm of introspection that is normally visited only during sleep can be enlightening or fiightening, enjoyable or depressing. Individual experiences are as varied as are people. Further, for any one person, no two episodes are the same. While there are a multiplicity of "mind events" that occur, some common characteristics are predictable for the state itself. Extrapolations of the "split brain" stuidies, performed earlier this decade, may lend new insight to the altered states of conciousness which are produced by N20/02. Some 16 to 20 epileptic patients with intractible bilateral seizuires were treated with a procedure termed "commissuirotomy." This neurosuirgical techniquie calls for a severing of the corpus callosuim, the main neuiral connection between the two cerebral hemispheres. It was postuilated that suich a sectioning wouild decrease the storm of electrical activity being experienced bilaterally duiring epileptic convuilsions. In many of these patients, seizuires were greatly reduiced or terminated completely. Professor Roger Sperry of the California Instituite of Technology and his associates performed an elaborate series of tests on these very special patients who, post-suirgically, literally had two independent brains. Cluies offered in the 4g4..yid.ij~~iil (which is controlled by the left cerehemis)her-e) elicited ve balobective reies. Similar clutes introdtuced in the left visuial field (contIolled by the ii hei eVoked non-verbal sulb jectiv e * apoises 'e~spIit brain" patients were tested in a myriad of different ways. These experiments and others uising bilateral electroence)halagrams on normal patients have proved
that wide disparity in fuinction exists between the hemispheres. That is, the right side of the brain processes n a nholly t manner rom t eleft side of the brain. We have intact connection
between thehalves of our brains; therefore, our consciousness has access to both types of function. Many of the chief researchers in the field believe that these modes of mentation are complementary but do not readily substitute for each other. Thus, we tend to alternate between hemispheres according to the type dof finction required. The bicameral nature of the brain is suggested in the following chart. Left Brain Right Brain 1. Verbal Non-Verbal Communication Communication (eg. gestures, intonation,
inflection, body language.)
2. Logical-Analytical 3. Sequential 4. Objective-Literal 5. Factual 6. Rational 7. Linear 8. Expressive LEFT BRAIN
Intuitive-Holistic Simultaneous
Subjective-Symbolic Fantasy Emotional
Holistic-Dimensional
Perceptive RIGHT BRAIN
~bral
150
ANESTHESIA PROGRESS
This dual nature can be understood as predominently e i n the lft and introspective on the ijgljit. Language, logic and objective reasoning are means by which we deal with outside reality. Intuition and emotion are means by which we feel an inner reality. The -omputer-likelI an constructs an ordered outlook emphasizing sequence and reason; nt brain constructs a "freeas'j ation" view-point whXch is simultaneouis and dimensi oal. In 1977, a study was done in which bilateral brain wave readings were recorded on a patient sedated with, N20/02. This project indicated increased night hemisphere activity corresponding to increases of d simultaneously decreased left hemisphere ac iviy. The findings were dric and reatble. No other variables such as music, visual cties, biofeedback signals, etc. were introduced. From this test and carefuil patient observations, it is possible to view the altered consciousness induced by N2as predominantly of the right hemisphere variehy. A patient sedated with nitrous oxide can be more conscious of what is in his thoughts than what is resent yironment. His mind may be filled in-his exte with a torrent of ideas simultaneously. It can be as if he is floating in a state of free association where a multitude of ideas are bumping into other seemingly unrelated ideas. In this holistic mind-set, the surreal is real; makes sense. A person under N20/02 analgesia is very stigestile, thus an ideal hypnotic subject. He may seem to be immersed in circular thinking; his conscious focus is open to be led by suggestion. The more deeply sedated a patient becomes, the less he relies on vbalomm6imunication. A good method for maintaining light analgesia is to ask the patient a question. A verbal reply, especially a full sentence, would usually indicate a lighter state. In initial nitrous oxide inductions, adult patients are usually very analytical. They attempt to scrutinize what they are experiencing. This analytic attempt may be seen as the left brain trying to remain dominant. Occasionally a "strong minded" individual will react negatively to reduction of left hemisphere fuinction while remaining conscious under N20/02. His response would be psychological in nature; he might tear off the mask, "freak out," get claustrophobic, etc. Ironically, such a patient may simply be gaining control of a different aspect of his own brain. > An excellent technique for preventing such negative response to analgesia is to establish, with minimtim concentrations, a light tingly state, while suggesting to the patient, "you may begin to feel slightly distant or dreamy . it will be a pleasant sensation where you can allow yotir thoughts to float . it's very normal for you to begin to have several thoughts at once . . . oIr to fantasize." As soon as the patient admits to feeling some changes, he should be oxygenated while saying, "the nicest part of this experience is the fact that we can completely control how relaxed you become by my giving you pure oxygen or by you breathing through youi mouth . . both these methods will NOVEMBER-DECEMBER 1979
clear you tip completely notice how you may already be clearing tip . since I have now administered ptire oxygen." By stiggesting that the patient open his eyes wide and raise his arms while spreading otit his fingers, we can asstire that he become ftilly conscious again. This method accomplishes several important tasks: 1. Familiarizes a patient with the sedated state. 2. Relieves the patient of the feeling he's going to surrender control of his mind. 3. Sanctions the "normalcy" of the state by variotis stiggestions. Ftirther sedation with this patient will tistially be uneventful and pleasant. The effect of otur tise of both verbal and non-verbal communication with otir sedated patients is a crucial matter. The softness and sincerity we display with our voices can be one of our best instrtiments for relaxing patients. As a patient reaches deeper stages of analgesia, how we say seems to be increasingly more important than wejsay Some of the most sticcessful inductions require very few words. A gesttire of empathy can accomplish far more than the most eloquent soliloqtiy. It is in the right hemisphere of the brain that we relate to the tonal aspects of mtisic. Careftully selected mtisic can be a powerful adjunctto analgesic procedures. We shouild endeavor to avoid harsh or "heavy" somnd-s becatise they cotld disrtipt patient relaxation. White Sound, a monotonous static at ftll consciousness, can be most soothing and settling to a patient sedated on N20/02. Further, White Sotind can deprive a patient of his negative atiditory associational memory; a factulty which often exaggerates reaction to dental procedtires. Recent theories on memory stuggest that the brain responds to sensoiy stimutli similarly to the manner in which a spectruim analyzer reacts to sotind. The inherent freqtiencies within a sotind "collide" with netironal memoiy circuits of like freqtiencies creating a hologrammic "print." The connotation of this engram is delivered by associational memoiy tracts. Thtis, a sotind stich as the dental drill can elicit negative response, even pain, of itself. The fantasy and emotional aspects of a iight brain state may fuirther exaggerate negative reactions of sedated patients. The phenomenon of tie istoition is anotlherpsychological phenomenon reported to occuII frequiently in consciotis sedation appointments. This process may be tunderstood as a right brain mode of viewing time. Left brain is sequeential seeing events as catisally linked in linear time. Right brain is simtiltaneotis and holistic viewing events in patterns or in a pictorial sense. Time, as we know it literally, allows Us to observe what we are consciotis of from several viewpoints (past, present and fuittire). On the other hand, oiii1 dreams, which are as real (they happen) as otur waking moments, seem to ocCIII in a single sphere of time. The ages of the participants in ouir dreams, the settings, the 6cctirrences are unrelated to what we normally view as chronological. Interestingly, these jtimbled scenarios always seem to make sense while they 151
sion, etc. can be very disturlbing to a dentist, as well as, disruptive of dental procedtures. Patients exhibiting emotional episodes are often embarrassed by such conduct. We may reassur-e suchl a patienit that his expressions are natuiral because they are produced by his own feelings. Events such as this, demand a great amouint of empathy. By "couipling" to a patient's genuine feelings, a dentist can lead a patient toward a more comfortable state of mind. "Mrs. Jones, I know how distressing the sotund of my drill may be to youi perhaps, we can place some earphones on youi and get you to listen to some music that will be more comforting to yoi." Anotlher technique involves suggestion; "Mrs. Jones, you mayj keeipyouir appointment as pleasant as possible by concentrating on the most positive and pleasant tlhoght YOU can
Associational memory can add either negative or positive connotation to events experienced. Inner visualizing imagery of a beach scene, presented verbally by a dentist, can be enhanced by pulsing white noise (which sounds like the surf) such that it supercedes simultaneous negative dental sensory stimuli.
are being experienced, within the context of the dream. Time distortion might be best comprehended as a shift to the more holistic right brain mode which sees all events in a single present moment. We can help make long appointments seem short by being aware of this time warp that can occur because of nitrous oxide. Simple suggestions can allow us to capitalize on time distortions such as, "you will notice how quickly the time will fly while you breath through your nose, and relax" or "continue to relax and allow your thoughts to be as pleasant as possible during the few short moments ahead of you in today's ,appointment . One of the major health problems of our time is n s. This psychological dilemma can be viewed as a failure to integrate our deepest feelings with our thoughts and actions. The limbic brain is equipped with powerfuil inhibitors which can prevent "undesirable" feelings from reaching ftill consciousness. People primarily tend to be more conscious of what is thought rather than what is felt. Neurotic behavior, such as pacing, loquacity, nail biting, finger tapping, etc. can be seen as uindelineated nervous activity resulting from separation or withdrawal from experiencing repressed emotions. N20/02 depresses limbic centers, thus patients are uisually more in contact with their feelings. This transient "connection" can be a benefit or a liability. Spontaneous laughter, crying, aggres.
152
Dur ing conscious sedation appointments, a dentist may steer patients toward positive introspection. A libraiy of tape cassettes with a variety of relaxing music can help maintain a relaxed and steady mood in the operatory.ZaI n can give patients an isolated (yet secuire) feeling, far from dental sounds. An altered conscious experience may be quite profound and miglht be fortified by a certain amouint of privacy, as well as, positive suggestion. The common public view of dentistry has been associated with aspects of fear and pain for too long. Dentists are experts at relieving pain and could be known for empathy and compassion for the apprehensive. Fear is an emotion which can cauise patients to ster al initfpse.pa&. even ayon treatment. Far can exa dental procedures. Frightened patients may be disruptive and stressfuil to all those around them. Our ability to empathize with patients who are afraid can be the critical factor in "winning them over" to good dentistry. An intuiitive and holistic outlook can afford us the most effective treatment for the frightened problem patient. Dental education holds the key to the fuiture focus of dentistry verses fear and apprehension. The ability to offer logical and reasonable treatment plans is instilled in us in dental school. We learn to explain objectirely the dangers of decay and periodontal disease. We were taught the facts about oral disease and etiology. We learned the language of our profession and how to express ourselves to our patients and each other. Our tfinigfom pre-school to post graduate school emhas ize.,~ t&P echnical approach to rq4lit Our knowledge tends to be weighted in favor of the literal. With this training as a background, we are seldom able to use perceptive right brain talents to help ourselves and our patients. A thorough knowledge of the psychological effects of N20/02 can afford us a valuable method for helping patients overcome dental fear. The development of intuitive capabilities gives us an edge in gearing our dental procedures in the right direction relative to patient needs and desires. A holistic recognition of the ANESTHESIA PROGRESS
patterns that cauise fear can enable uis to find effective means for overcoming patient anxiety. Development of ouir own iight brain talents will increase creative insMhi make us more aware of the total health picture (not only for our patients, buit also ouirselves) and allow uis to commuinicate more effectively. Discovery that one half of our cerebral tissuie is devoted to a form of cognition distinct from rational, logical, analytical mentation can, serve as motivation for uis to acquiire new special skills. Increased creativity, perception, empathy and expression, greater appreciation of muisic and humor are but a few ofthe side effects of a right brain approach. The inherent capabilities for inducing right mode activity, which N20/02 possesses, may lead uis toward new techniques for reducing or eliminating fear. The better we are able to understand the psychological ramifications of inhalation of N20, the higher will be our aptitutde for helping our patients achieve relaxation. The attainment of such a goal will carry with it many hidden benefits. One suich reward is a diminuition of stress in our lives. 7200 E. Dry Creek Rd. Englewood, Colorado 80112
REFERENCES
Diamond Stuiart J & Miller Graham Hemisphere Function in the Human Brain A Halsted Press Book John Wilky and Sons New York 1974. Eccles Sir John The UTnderstanding of the Brain McGraw Hill 1973. Ferguison Marilyn The Brain Revolution Taplinger New York 1974. Janov Arthuir The Anatomy of Mental Illness Berkley Publishing Corporation New York 1977. Jaynes Juilian The Origin of Consciousness in the Breakdown of the Bicameral Mind Houighton Mifflin Company Boston 1976. Ornstein Robert E The Mind Field A Personal Essay, Pocket Books New York 1978. Ornstein Robert E The Psychology of Consciousness W H Freeman and Company San Francisco 1972. Pelletier Kenneth R Towards a Science of Consciousness Dell Publishing Company New York 1979. Rand McNally and Company The Rand McNally Atlas of the Body and Mind New York, Chicago, San Francisco 1977. Sagan Carl Broca's Brain Random Hotuse Inc New York 1979. Sagan Carl Dragons of Eden - Speculations on the Evolution of Human Intelligence Random Houise New York 1977. Time-Life Books The Role of the Brain Ronald H Bailey and the Editors of Time-Life Books on Human Behavior Time-Life Books New York 1975.
'I'he Legion of \lerit THE LEGION OF MERIT WAS RECENTLY AWARDED to COLONEL LEE GETTER, Dental Corps
FOR exceptionally meritorious conduct in the performance of outstanding services while serving as Commander, U. S. Army Dental Activity, Fort George G. Meade, Maryland; as Chief Dental Consultant to The Surgeon General of the Army; and in other responsible duty and teaching positions throughout his career. Colonel Getter's broad professional knowledge and experience gained for him the well deserved respect of his peers, both military and civilian. He never failed to demonstrate the highest degree of leadership, devotion to duty, and professional competence. Colonel Getter's distinguished performance of duty through his career reflects great credit upon himself, the Army Dental Care System, and the United States Army.
s/Marshall E. McCabe MARSHALL E. McCABE, M.D. Major General, MC Commanding
NOVEMBER-DECEMBER 1979
s/Clifford C. Alexander, Jr. SECRETARY OF THE ARMY August 31, 1979.
153
of
ConsciolS Sedation
Robert Minnis D.D.S.
The most profound changes that take place under N20/02 sedation are psychological in nature. The term "euphoria" is often used to "explain" the expanded sense of well being brought about under analgesia. Time distortion is mentioned as a side effect of the deeper stages of nitrous sedation. Some literature in the past has referred to the "high" feeling induced by N20/02. These attempts to explain what occurs when a person experiences conscious sedation are only small pieces of a very elaborate and complex profile which is beginning to unfold due to recent findings in the neurosciences. To best appreciate the psychological changes that occur tinder N20/02, one might experience those changes. However, this approach most often leaves one at a loss for language to describe the state; it can be an ineffable, inexplicable feeling. There is so much that occurs within the spectrum of our consciousness that does not lend itself to expression in words. A conscious "journey" into that realm of introspection that is normally visited only during sleep can be enlightening or fiightening, enjoyable or depressing. Individual experiences are as varied as are people. Further, for any one person, no two episodes are the same. While there are a multiplicity of "mind events" that occur, some common characteristics are predictable for the state itself. Extrapolations of the "split brain" stuidies, performed earlier this decade, may lend new insight to the altered states of conciousness which are produced by N20/02. Some 16 to 20 epileptic patients with intractible bilateral seizuires were treated with a procedure termed "commissuirotomy." This neurosuirgical techniquie calls for a severing of the corpus callosuim, the main neuiral connection between the two cerebral hemispheres. It was postuilated that suich a sectioning wouild decrease the storm of electrical activity being experienced bilaterally duiring epileptic convuilsions. In many of these patients, seizuires were greatly reduiced or terminated completely. Professor Roger Sperry of the California Instituite of Technology and his associates performed an elaborate series of tests on these very special patients who, post-suirgically, literally had two independent brains. Cluies offered in the 4g4..yid.ij~~iil (which is controlled by the left cerehemis)her-e) elicited ve balobective reies. Similar clutes introdtuced in the left visuial field (contIolled by the ii hei eVoked non-verbal sulb jectiv e * apoises 'e~spIit brain" patients were tested in a myriad of different ways. These experiments and others uising bilateral electroence)halagrams on normal patients have proved
that wide disparity in fuinction exists between the hemispheres. That is, the right side of the brain processes n a nholly t manner rom t eleft side of the brain. We have intact connection
between thehalves of our brains; therefore, our consciousness has access to both types of function. Many of the chief researchers in the field believe that these modes of mentation are complementary but do not readily substitute for each other. Thus, we tend to alternate between hemispheres according to the type dof finction required. The bicameral nature of the brain is suggested in the following chart. Left Brain Right Brain 1. Verbal Non-Verbal Communication Communication (eg. gestures, intonation,
inflection, body language.)
2. Logical-Analytical 3. Sequential 4. Objective-Literal 5. Factual 6. Rational 7. Linear 8. Expressive LEFT BRAIN
Intuitive-Holistic Simultaneous
Subjective-Symbolic Fantasy Emotional
Holistic-Dimensional
Perceptive RIGHT BRAIN
~bral
150
ANESTHESIA PROGRESS
This dual nature can be understood as predominently e i n the lft and introspective on the ijgljit. Language, logic and objective reasoning are means by which we deal with outside reality. Intuition and emotion are means by which we feel an inner reality. The -omputer-likelI an constructs an ordered outlook emphasizing sequence and reason; nt brain constructs a "freeas'j ation" view-point whXch is simultaneouis and dimensi oal. In 1977, a study was done in which bilateral brain wave readings were recorded on a patient sedated with, N20/02. This project indicated increased night hemisphere activity corresponding to increases of d simultaneously decreased left hemisphere ac iviy. The findings were dric and reatble. No other variables such as music, visual cties, biofeedback signals, etc. were introduced. From this test and carefuil patient observations, it is possible to view the altered consciousness induced by N2as predominantly of the right hemisphere variehy. A patient sedated with nitrous oxide can be more conscious of what is in his thoughts than what is resent yironment. His mind may be filled in-his exte with a torrent of ideas simultaneously. It can be as if he is floating in a state of free association where a multitude of ideas are bumping into other seemingly unrelated ideas. In this holistic mind-set, the surreal is real; makes sense. A person under N20/02 analgesia is very stigestile, thus an ideal hypnotic subject. He may seem to be immersed in circular thinking; his conscious focus is open to be led by suggestion. The more deeply sedated a patient becomes, the less he relies on vbalomm6imunication. A good method for maintaining light analgesia is to ask the patient a question. A verbal reply, especially a full sentence, would usually indicate a lighter state. In initial nitrous oxide inductions, adult patients are usually very analytical. They attempt to scrutinize what they are experiencing. This analytic attempt may be seen as the left brain trying to remain dominant. Occasionally a "strong minded" individual will react negatively to reduction of left hemisphere fuinction while remaining conscious under N20/02. His response would be psychological in nature; he might tear off the mask, "freak out," get claustrophobic, etc. Ironically, such a patient may simply be gaining control of a different aspect of his own brain. > An excellent technique for preventing such negative response to analgesia is to establish, with minimtim concentrations, a light tingly state, while suggesting to the patient, "you may begin to feel slightly distant or dreamy . it will be a pleasant sensation where you can allow yotir thoughts to float . it's very normal for you to begin to have several thoughts at once . . . oIr to fantasize." As soon as the patient admits to feeling some changes, he should be oxygenated while saying, "the nicest part of this experience is the fact that we can completely control how relaxed you become by my giving you pure oxygen or by you breathing through youi mouth . . both these methods will NOVEMBER-DECEMBER 1979
clear you tip completely notice how you may already be clearing tip . since I have now administered ptire oxygen." By stiggesting that the patient open his eyes wide and raise his arms while spreading otit his fingers, we can asstire that he become ftilly conscious again. This method accomplishes several important tasks: 1. Familiarizes a patient with the sedated state. 2. Relieves the patient of the feeling he's going to surrender control of his mind. 3. Sanctions the "normalcy" of the state by variotis stiggestions. Ftirther sedation with this patient will tistially be uneventful and pleasant. The effect of otur tise of both verbal and non-verbal communication with otir sedated patients is a crucial matter. The softness and sincerity we display with our voices can be one of our best instrtiments for relaxing patients. As a patient reaches deeper stages of analgesia, how we say seems to be increasingly more important than wejsay Some of the most sticcessful inductions require very few words. A gesttire of empathy can accomplish far more than the most eloquent soliloqtiy. It is in the right hemisphere of the brain that we relate to the tonal aspects of mtisic. Careftully selected mtisic can be a powerful adjunctto analgesic procedures. We shouild endeavor to avoid harsh or "heavy" somnd-s becatise they cotld disrtipt patient relaxation. White Sound, a monotonous static at ftll consciousness, can be most soothing and settling to a patient sedated on N20/02. Further, White Sotind can deprive a patient of his negative atiditory associational memory; a factulty which often exaggerates reaction to dental procedtires. Recent theories on memory stuggest that the brain responds to sensoiy stimutli similarly to the manner in which a spectruim analyzer reacts to sotind. The inherent freqtiencies within a sotind "collide" with netironal memoiy circuits of like freqtiencies creating a hologrammic "print." The connotation of this engram is delivered by associational memoiy tracts. Thtis, a sotind stich as the dental drill can elicit negative response, even pain, of itself. The fantasy and emotional aspects of a iight brain state may fuirther exaggerate negative reactions of sedated patients. The phenomenon of tie istoition is anotlherpsychological phenomenon reported to occuII frequiently in consciotis sedation appointments. This process may be tunderstood as a right brain mode of viewing time. Left brain is sequeential seeing events as catisally linked in linear time. Right brain is simtiltaneotis and holistic viewing events in patterns or in a pictorial sense. Time, as we know it literally, allows Us to observe what we are consciotis of from several viewpoints (past, present and fuittire). On the other hand, oiii1 dreams, which are as real (they happen) as otur waking moments, seem to ocCIII in a single sphere of time. The ages of the participants in ouir dreams, the settings, the 6cctirrences are unrelated to what we normally view as chronological. Interestingly, these jtimbled scenarios always seem to make sense while they 151
sion, etc. can be very disturlbing to a dentist, as well as, disruptive of dental procedtures. Patients exhibiting emotional episodes are often embarrassed by such conduct. We may reassur-e suchl a patienit that his expressions are natuiral because they are produced by his own feelings. Events such as this, demand a great amouint of empathy. By "couipling" to a patient's genuine feelings, a dentist can lead a patient toward a more comfortable state of mind. "Mrs. Jones, I know how distressing the sotund of my drill may be to youi perhaps, we can place some earphones on youi and get you to listen to some music that will be more comforting to yoi." Anotlher technique involves suggestion; "Mrs. Jones, you mayj keeipyouir appointment as pleasant as possible by concentrating on the most positive and pleasant tlhoght YOU can
Associational memory can add either negative or positive connotation to events experienced. Inner visualizing imagery of a beach scene, presented verbally by a dentist, can be enhanced by pulsing white noise (which sounds like the surf) such that it supercedes simultaneous negative dental sensory stimuli.
are being experienced, within the context of the dream. Time distortion might be best comprehended as a shift to the more holistic right brain mode which sees all events in a single present moment. We can help make long appointments seem short by being aware of this time warp that can occur because of nitrous oxide. Simple suggestions can allow us to capitalize on time distortions such as, "you will notice how quickly the time will fly while you breath through your nose, and relax" or "continue to relax and allow your thoughts to be as pleasant as possible during the few short moments ahead of you in today's ,appointment . One of the major health problems of our time is n s. This psychological dilemma can be viewed as a failure to integrate our deepest feelings with our thoughts and actions. The limbic brain is equipped with powerfuil inhibitors which can prevent "undesirable" feelings from reaching ftill consciousness. People primarily tend to be more conscious of what is thought rather than what is felt. Neurotic behavior, such as pacing, loquacity, nail biting, finger tapping, etc. can be seen as uindelineated nervous activity resulting from separation or withdrawal from experiencing repressed emotions. N20/02 depresses limbic centers, thus patients are uisually more in contact with their feelings. This transient "connection" can be a benefit or a liability. Spontaneous laughter, crying, aggres.
152
Dur ing conscious sedation appointments, a dentist may steer patients toward positive introspection. A libraiy of tape cassettes with a variety of relaxing music can help maintain a relaxed and steady mood in the operatory.ZaI n can give patients an isolated (yet secuire) feeling, far from dental sounds. An altered conscious experience may be quite profound and miglht be fortified by a certain amouint of privacy, as well as, positive suggestion. The common public view of dentistry has been associated with aspects of fear and pain for too long. Dentists are experts at relieving pain and could be known for empathy and compassion for the apprehensive. Fear is an emotion which can cauise patients to ster al initfpse.pa&. even ayon treatment. Far can exa dental procedures. Frightened patients may be disruptive and stressfuil to all those around them. Our ability to empathize with patients who are afraid can be the critical factor in "winning them over" to good dentistry. An intuiitive and holistic outlook can afford us the most effective treatment for the frightened problem patient. Dental education holds the key to the fuiture focus of dentistry verses fear and apprehension. The ability to offer logical and reasonable treatment plans is instilled in us in dental school. We learn to explain objectirely the dangers of decay and periodontal disease. We were taught the facts about oral disease and etiology. We learned the language of our profession and how to express ourselves to our patients and each other. Our tfinigfom pre-school to post graduate school emhas ize.,~ t&P echnical approach to rq4lit Our knowledge tends to be weighted in favor of the literal. With this training as a background, we are seldom able to use perceptive right brain talents to help ourselves and our patients. A thorough knowledge of the psychological effects of N20/02 can afford us a valuable method for helping patients overcome dental fear. The development of intuitive capabilities gives us an edge in gearing our dental procedures in the right direction relative to patient needs and desires. A holistic recognition of the ANESTHESIA PROGRESS
patterns that cauise fear can enable uis to find effective means for overcoming patient anxiety. Development of ouir own iight brain talents will increase creative insMhi make us more aware of the total health picture (not only for our patients, buit also ouirselves) and allow uis to commuinicate more effectively. Discovery that one half of our cerebral tissuie is devoted to a form of cognition distinct from rational, logical, analytical mentation can, serve as motivation for uis to acquiire new special skills. Increased creativity, perception, empathy and expression, greater appreciation of muisic and humor are but a few ofthe side effects of a right brain approach. The inherent capabilities for inducing right mode activity, which N20/02 possesses, may lead uis toward new techniques for reducing or eliminating fear. The better we are able to understand the psychological ramifications of inhalation of N20, the higher will be our aptitutde for helping our patients achieve relaxation. The attainment of such a goal will carry with it many hidden benefits. One suich reward is a diminuition of stress in our lives. 7200 E. Dry Creek Rd. Englewood, Colorado 80112
REFERENCES
Diamond Stuiart J & Miller Graham Hemisphere Function in the Human Brain A Halsted Press Book John Wilky and Sons New York 1974. Eccles Sir John The UTnderstanding of the Brain McGraw Hill 1973. Ferguison Marilyn The Brain Revolution Taplinger New York 1974. Janov Arthuir The Anatomy of Mental Illness Berkley Publishing Corporation New York 1977. Jaynes Juilian The Origin of Consciousness in the Breakdown of the Bicameral Mind Houighton Mifflin Company Boston 1976. Ornstein Robert E The Mind Field A Personal Essay, Pocket Books New York 1978. Ornstein Robert E The Psychology of Consciousness W H Freeman and Company San Francisco 1972. Pelletier Kenneth R Towards a Science of Consciousness Dell Publishing Company New York 1979. Rand McNally and Company The Rand McNally Atlas of the Body and Mind New York, Chicago, San Francisco 1977. Sagan Carl Broca's Brain Random Hotuse Inc New York 1979. Sagan Carl Dragons of Eden - Speculations on the Evolution of Human Intelligence Random Houise New York 1977. Time-Life Books The Role of the Brain Ronald H Bailey and the Editors of Time-Life Books on Human Behavior Time-Life Books New York 1975.
'I'he Legion of \lerit THE LEGION OF MERIT WAS RECENTLY AWARDED to COLONEL LEE GETTER, Dental Corps
FOR exceptionally meritorious conduct in the performance of outstanding services while serving as Commander, U. S. Army Dental Activity, Fort George G. Meade, Maryland; as Chief Dental Consultant to The Surgeon General of the Army; and in other responsible duty and teaching positions throughout his career. Colonel Getter's broad professional knowledge and experience gained for him the well deserved respect of his peers, both military and civilian. He never failed to demonstrate the highest degree of leadership, devotion to duty, and professional competence. Colonel Getter's distinguished performance of duty through his career reflects great credit upon himself, the Army Dental Care System, and the United States Army.
s/Marshall E. McCabe MARSHALL E. McCABE, M.D. Major General, MC Commanding
NOVEMBER-DECEMBER 1979
s/Clifford C. Alexander, Jr. SECRETARY OF THE ARMY August 31, 1979.
153
