SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability
Author(s): M. Keddie, H. Vincer, P. Shah, M. Doshi 

Abstract: 

Introduction
When providing intravenous sedation for patients with severe disabilities who have limited verbal communication it can sometimes be challenging to identify when sedation endpoint is reached. Bispectral index monitoring can provide an objective measure of the depth of sedation.

Aim
This study aims to assess the feasibility of bispectral index monitoring in adults with cognitive impairment with limited to no verbal communication undergoing dental treatment with midazolam conscious sedation.

Method
Bispectral monitoring was applied to patients with a neurodisability or a learning disability who were undergoing dental treatment under intravenous sedation, across three sites. A researcher observed whether the sensor could be applied and how the bispectral index changed during sedation and recovery.

Results
31 patients were recruited. In most cases it was possible to apply sensors before, or soon after, midazolam was titrated. A pattern of a decrease in bispectral values towards the end point, and an increase towards recovery was noted. Fluctuations in bispectral readings were seen during treatment, likely due to facial muscle movements.

Conclusion
Bispectral index monitoring could be a valuable adjunct when training dentists in sedation in special care dentistry and may be of particular use in patients with neurodisability.

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: A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry
Author(s): M. Ismail, S. Nayani-Low, B. Kerr
Abstract: 

Aim
To evaluate the the understanding, proficiency, confidence with and anticipated usefulness of common airway assessment techniques when assessing patients for provision of conscious sedation amongst dental sedationists.

Methods
An online questionnaire was sent to conscious sedation providers in dentistry in the UK. The questionnaire explored current practice, use and documentation of airway assessment and information regarding airway-related complications experienced.

Results
254 responses were received. 67% routinely carried out airway assessment whilst 40% documented this finding most or all the time. The average number of airway assessment techniques known was 3.96 of 8. The most common technique known was measurement of mouth opening (71%); this was the most used, the technique participants were most confident using, and the technique found to be the most useful. 11% had experienced an incident where obstruction or hypoxia had occurred where an airway assessment could have predicted this.

Conclusions
The need for airway assessment is recognised within current guidelines and this study illustrates dentists do routinely carry out airway assessment. The technique used, documentation and level of training are varied. A uniform approach to training and the use of a formalised tool may help improve application of airway assessment in sedation in dentistry.

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: Improving safety and efficiency in special care dentistry through quality improvement of patient information in the Belfast Trust
Author(s): L. Cullen, K. McKenna

Abstract: 

The Belfast Health and Social Care Trust’s Special Care Dentistry unit provides treatment under conscious sedation and general anaesthetic. Patients were sent generic preoperative information which was not in a user friendly format for special care dentistry. This presented a patient safety issue with reliance on staff to verbally reinforce information.

Through a quality improvement project we aimed to design a new patient information leaflet to improve safety and clinical effectiveness; incorporate guidance and reduce variation; improve patient experience and improve efficiency within our service by reducing staff administration time.

Plan Do Study Act (PDSA) cycles collated information from dental trainees, nurses and patients. Patient and carer feedback was sought on the quality and usefulness of information. We utilised patient feedback and a reading group to develop a new special care dentistry preoperative information leaflet.

Through quality improvement and service user engagement we have improved patient safety and satisfaction and improved efficiency through the standardisation of pre-operative information.

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: Patient experiences and outcomes following intravenous sedation in an oral surgery setting
Author(s): A.K. Lamba, A. Heewa, O. Johnson King, M. Eghtessad

Abstract: 

Intravenous sedation is a widely used method of providing elective dental treatment to patients that may be anxious, have a gag reflex or who are undergoing a difficult surgical procedure when local or general anaesthetic on its own is contraindicated. A telephone questionnaire was conducted post extraction for those who had undergone treatment under intravenous sedation at the Royal National ENT and Eastman Dental Hospital in 2017 and 2021. We aimed to evaluate the service and demonstrate patient reported experiences and outcomes of intravenous sedation as a method for oral surgical procedures.

Results were positive, with 100% of patients opting to use this method again for dental treatment and 100% of patients recommending this method to friends and family if they were to undergo a similar procedure.

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

Articles from Digest 40(1)