Are You Suitable for Day Case IV Sedation?

Before considering dental treatment under conscious sedation all the alternative methods of anxiety management should be attempted. However, the provision of adequate anxiety control is an integral part of the practice of dentistry. The General Dental Council has indicated that this is both a right for the patient and a duty of the dentist.

All patients deserve appropriate anxiety control for any dental procedure; in order to be appropriate the methods used must be considered for the individual patient having a specific treatment. At the Chadwell Heath Anaesthetic Clinic conscious sedation is provided for the nervous patient. Conscious sedation is defined as maintaining verbal contact with the patient at all times during the procedure and the patient’s protective reflexes are maintained (whereas in general anaesthesia these are lost).

Principles of Good Sedation Practice

Good sedation practice requires practitioners to consider a range of non-pharmacological and pharmacological methods of anxiety management in treatment planning for individual patients. It is essential that conscious sedation be provided to the highest possible standards.

Recording of blood pressure is part of the assessment process for all patients having intravenous sedation, unless lack of patient compliance renders pre-sedation measurement impossible. Facilities at the Chadwell Heath Sedation Clinic

Treatment and recovery areas are large enough to enable adequate access for the dental and medical care team. All equipment and drugs recommended for treating medical emergencies and sedation-related complications are immediately available. The equipment is constantly maintained and serviced every 6 months.

The clinic has a purpose built recovery room and is staffed by a team of qualified recovery nurses.

Equipment

All sedation surgeries are equipped with necessary monitoring equipment as recommended by the Royal College of Anaesthetists. Such machines are maintained according to manufacturers’ guidance with regular, documented servicing.

Are you a Candidate for Day Case Sedation Dentistry?

If you have any of the following – the answer could be yes:

  • Fear of dental treatment
  • History of traumatic dental experiences
  • Difficulty getting numb
  • Very sensitive gag reflex or difficulty opening
  • Extremely sensitive teeth
  • Medical conditions potentially aggravated by stress
  • Special needs
  • Often make and then cancel dental appointments

Many people are fearful of dental treatment, which is often based on a past experience of something unpleasant happening at the dentist.

Sedation Facts:

  • You may have little or no memory of the experience.
  • You may not remember any sounds or smells.

Patients with any of the following conditions are NOT SUITABLE as day cases.

Social Circumstances

  • Living alone with no responsible adult to look after the patient after leaving the clinic.
  • No responsible adult to accompany the patient home.
  • No access to a hospital.

History

A thorough medical, dental and social history is taken to ensure that the conscious sedation technique chosen is the most appropriate to enable treatment to be carried out for each individual.

Language

Non-English speakers without an interpreter cannot be treated

Chronic Diseases

  • Severe Arterial path.
  • Sickle Cell Anaemia.
  • Thalassaemia.
  • Bleeding Disorders.
  • Chronic Neurological Disease e.g. Multiple Sclerosis.
  • Severe Rheumatoid Arthritis.
  • Severe Renal Disease.
  • Porphyria.
  • Hypertension.

Patients with unexpected diastolic pressure of 100 mm Hg on more than two separate readings during assessment.

Cardiac

  • Myocardial infarction in the last twelve months
  • Patients with severe cardiac symptoms

Asthma

Patients who have required Steroids for prolonged periods in the last 6 months.

Diabetes Mellitus

Unstable diabetes.

Age

Children under 3 years of age or under 15KGs

Other

Known DRUG ADDICTS or ALCOHOLICS.

Previous Anaesthetic History

Any complications in patient’s previous anaesthetic history, including any close relatives.

Epilepsy

  • A patient who has had more than one major convulsion within previous 6 months
  • A patient who is controlled with medication is suitable for day case.

Obesity

Clinically Obese

Medication

  • Steroids
  • MAO inhibitors
  • Anticoagulants
Most patients do not require routine pre-operative investigations, however, there are exceptions:
  • Sickle Cell Test
  • Other Tests- to be decided by the anaesthetist after assessing the patients.

Intravenous Sedation

Intravenous sedation at The Chadwell Heath Anaesthetic Clinic is commonly achieved by the injection of a single drug. In addition, there are a number of other techniques. These include the use of combinations of sedative drugs and/or inhalation sedation. Intravenous access by way of a cannula is always maintained until discharge.

The usual technique for intravenous sedation is the use of a titrated dose of midazolam. Sedation using multiple intravenous drugs, intravenous drugs in combination with inhalation sedation, or infusion of short-acting agents is also used in certain circumstances in order to achieve comfortable sedation.

It is particularly emphasized that sedation using multiple intravenous drugs, intravenous drugs in combination with inhalation sedation, or infusion of short-acting agents is always restricted to a fully trained and experienced medical practitioner and team working in an appropriate environment.

Recovery

Recovery from sedation is a progressive step-down from completion of treatment, through to the patient’s discharge into the care of a responsible adult escort. A specially trained recovery nurse looks after the patient after the dental treatment is complete. The patient will be monitored throughout their time in recovery and will then be discharged by the sedationist on duty.

All patients are individually assessed for their suitability to be discharged by the trained recovery nurse and patients are only allowed to leave when they have returned to a normal level of responsiveness and orientation for age and mental status and can walk unaided (if appropriate).

The patient and escort are always provided with written details of post-operative risks, pain control and management of possible complications. Patients are given information regarding aftercare arrangements and emergency contacts.