A prospective audit to investigate the level of consciousness of children requiring conscious sedation using an 'alternative technique'.

SAAD Dig. 2009 Jan; 25:15-21.SD

The aim of this prospective pragmatic audit was to investigate the level of consciousness experienced by children requiring conscious sedation in a primary care sedation service, using an 'alternative technique' to avoid referral to hospital for general anaesthesia. This technique was only applied to children who were unable to accept treatment with the use of standard inhalation sedation. The technique involved titrated inhaled oxygen and nitrous oxide and titrated sevoflurane with intravenous fentanyl and titrated midazolam. The described technique was provided by an experienced team with appropriate facilities that complied with contemporary standards and guidance. During treatment and recovery the consciousness level of children was recorded using a modified Wilson's scale. Of the sample of 573 children who received the audited technique, 1.9% (11 children) scored level 5 on the modified Wilson scale (eyes closed but responsive to mild physical stimulus). Due to the fine control this technique offers, the duration of this level of consciousness was for mostly less than a minute and no more than five minutes. No children became unresponsive. The results of this audit demonstrate that the technique meets current standards and guidelines for 'alternative' conscious sedation, with a wide margin of safety and the rendering of loss of consciousness unlikely. 99% of patients who would otherwise have required general anaesthetic for dental treatment successfully completed their treatment using this technique.