SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
Author(s): J. Li, J. Joseph, X. Yeo, H. Hossenally

Abstract: 

Introduction
Dentist-led conscious sedation improves access to dental care for patients with a learning disability (LD) and autism spectrum disorder (ASD). This service evaluation investigated cases of unsuccessful sedation to study the demographic and trend.

Aims

• To evaluate the reasons for failure of intranasal, oral, and intravenous (IV) conscious sedation
• To assess if there is a correlation between patient factors and sedation failure
• To identify if there are ways to improve the success of conscious sedation for patients with LD and ASD.

Methodology
A retrospective review of clinical notes of unsuccessful sedation cases was conducted from January 2019 to July 2021 across two dental services in London. Unsuccessful sedation was defined as ‘planned treatment unable to be carried out in its entirety, not including treatment modifications’.

Results
A total of 452 patients with LD / ASD were included. Unsuccessful sedation was reported in 34 cases (7.5%). All patients lacked capacity and 62% were non-verbal. Reasons for failure included: failure to cannulate (44%); movement (38%); challenging behaviour (9%); inability to maintain satisfactory oxygen saturation (3%); and short sedation window (6%). The mean dose of IV midazolam administered was 8 mg (range 2 - 18 mg).

Conclusion
Multiple patient factors play a role in unsuccessful sedation. Improved and standardised documentation of sedation and operating conditions are needed to facilitate further evaluation.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Are we providing an effective sedation service? An evaluation of a new conscious sedation service in primary special dental care
Author(s): C. Boynton, S. Harford, S. Spence

Abstract: 

Conscious sedation using midazolam can be an effective primary care dental treatment modality for patients with both dental anxiety and additional needs. This retrospective service evaluation aims to assess the efficacy of conscious sedation with midazolam in a new special care primary dental service, by identifying whether midazolam provided operating conditions sufficient to allow planned dental treatment to be completed.

Individual electronic records of patients treated with conscious sedation with midazolam by the West Dorset Special Care Primary Care Dental Service during the first nine months were examined. Efficacy of midazolam was evaluated using patient sedation scores and operating conditions.

Planned treatment was successfully completed in 37 out of the 41 appointments (90%). Four patients were unable to have treatment carried out for reasons including cannulation refusal, suboptimal co-operation and vomiting.

This study demonstrates that delivering dentist-led conscious sedation with midazolam in a primary care setting is a highly effective, cost- efficient alternative to general anaesthesia for a range of patients with anxiety and / or additional needs, and has significant potential to reduce wait times. However, the technique requires appropriately trained staff, careful patient selection together with suitable premises and equipment in line with evidence-based national policy and guidelines.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison
Author(s): H. J. Smith, R. Jaffery 

Abstract: 

Background
Flumazenil is a benzodiazepine antagonist which acts at GABA receptor sites to reverse the sedation effects of midazolam in dental conscious sedation. National Patient Safety Agency Rapid Response Report 2008 identified several cases where patients were being over sedated with midazolam and recommended auditing of flumazenil use as a measure of midazolam oversedation.

Aims
The audit aims to review the number of patients within the Birmingham Community Healthcare NHS Foundation Trust’s Community Dental Service who underwent sedation with midazolam and those who required reversal with flumazenil. It also aims to review the record keeping of the justifications given for flumazenil reversal and to ensure compliance with National Patient Safety Agency’s 2008 recommendations. 

Methods
Data for patients who underwent intravenous / transmucosal sedation with midazolam between January 2023 and June 2023 were taken from the Community Dental Service’s electronic logbook. Clinical records were then reviewed for documentation of justification.

Results
For cycle seven, (0%) no anxious adult patients required reversal with flumazenil, whereas 5.6% of special care patients (n = 5) required reversal. The majority of reversals cited prolonged recovery as the reason for its use.

Conclusion
The findings demonstrate compliance with National Patient Safety Agency’s recommendations, excellent record keeping and justification of flumazenil use.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars
Author(s): T. Ng

Abstract: 

A 12-year-old patient was referred into the community dental service by their general dental practitioner following an orthodontic opinion. Clinical and radiographic examination revealed molar incisor hypomineralisation with grossly broken down UR6 and UL6. In addition to hypodontia, the LL5 was not present and a retained LLE was in situ. The patient was advised removal of UL6, UR6, LLE, LRE by the orthodontist. The patient had never received dental treatment and was anxious. The patient successfully completed treatment with inhalation sedation for the removal of LRE and LLE and intravenous sedation for the removal of UR6 and UL6. 

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)