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Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K.
SAAD Dig. 2011 Jan; 27:24-9.SD

Abstract

BACKGROUND

Child dental anxiety is widespread, and it is not always possible to treat children using traditional methods such as behavioural management, local anaesthesia and even relative analgesia. In such cases a dental general anaesthetic (DGA) is the only option available to facilitate dental treatment in anxious children.

AIM

This study describes an advanced conscious sedation protocol which allows invasive treatment to be carried out in anxious children. It incorporates the use of titrated intravenous midazolam and fentanyl and inhalation agents, sevoflurane and nitrous oxide/oxygen, which is administered by a Consultant Anaesthetist. The aim is to produce an evidence- based study which can offer a sedation technique as a safe and effective alternative to a DGA.

STUDY DESIGN

Retrospective audit.

METHOD

267 clinical records were audited retrospectively from a specialist sedation-based clinic, for children aged 5-15 years old. The subjects all underwent invasive dental procedures with this technique between August and November 2008 as an alternative to a DGA.

RESULTS

262/267 (98%) of the subjects were treated safely and successfully and without the loss of verbal communication using this technique. This included many treatments requiring four quadrant dentistry, with both restorations and extractions as necessary being carried out in one visit. 5 subjects (2%) did not tolerate treatment and had to be referred for a DGA. No medical emergencies occurred.

CONCLUSIONS

Based on the evidence for this group of patients, this advanced conscious sedation technique, offers a safe and effective alternative to DGA. This technique must be carried out in an appropriate environment by an appropriately trained and experienced team who are able to comply with the recommendations for "alternative" sedation techniques.

Authors+Show Affiliations

Department of Child Dental Health, Newcastle Dental Hospital.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21323033

Citation

Hand, Darren, et al. "Advanced Paediatric Conscious Sedation: an Alternative to Dental General Anaesthetic in the U.K." SAAD Digest, vol. 27, 2011, pp. 24-9.
Hand D, Averley P, Lyne J, et al. Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K. SAAD Dig. 2011;27:24-9.
Hand, D., Averley, P., Lyne, J., & Girdler, N. (2011). Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K. SAAD Digest, 27, 24-9.
Hand D, et al. Advanced Paediatric Conscious Sedation: an Alternative to Dental General Anaesthetic in the U.K. SAAD Dig. 2011;27:24-9. PubMed PMID: 21323033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K. AU - Hand,Darren, AU - Averley,Paul, AU - Lyne,John, AU - Girdler,Nick, PY - 2011/2/18/entrez PY - 2011/2/18/pubmed PY - 2011/4/22/medline SP - 24 EP - 9 JF - SAAD digest JO - SAAD Dig VL - 27 N2 - BACKGROUND: Child dental anxiety is widespread, and it is not always possible to treat children using traditional methods such as behavioural management, local anaesthesia and even relative analgesia. In such cases a dental general anaesthetic (DGA) is the only option available to facilitate dental treatment in anxious children. AIM: This study describes an advanced conscious sedation protocol which allows invasive treatment to be carried out in anxious children. It incorporates the use of titrated intravenous midazolam and fentanyl and inhalation agents, sevoflurane and nitrous oxide/oxygen, which is administered by a Consultant Anaesthetist. The aim is to produce an evidence- based study which can offer a sedation technique as a safe and effective alternative to a DGA. STUDY DESIGN: Retrospective audit. METHOD: 267 clinical records were audited retrospectively from a specialist sedation-based clinic, for children aged 5-15 years old. The subjects all underwent invasive dental procedures with this technique between August and November 2008 as an alternative to a DGA. RESULTS: 262/267 (98%) of the subjects were treated safely and successfully and without the loss of verbal communication using this technique. This included many treatments requiring four quadrant dentistry, with both restorations and extractions as necessary being carried out in one visit. 5 subjects (2%) did not tolerate treatment and had to be referred for a DGA. No medical emergencies occurred. CONCLUSIONS: Based on the evidence for this group of patients, this advanced conscious sedation technique, offers a safe and effective alternative to DGA. This technique must be carried out in an appropriate environment by an appropriately trained and experienced team who are able to comply with the recommendations for "alternative" sedation techniques. SN - 0049-1160 UR - https://www.unboundmedicine.com/medline/citation/21323033/Advanced_paediatric_conscious_sedation:_an_alternative_to_dental_general_anaesthetic_in_the_U_K_ L2 - https://ClinicalTrials.gov/search/term=21323033 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -