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Conscious sedation 

Conscious sedation
Chapter:
Conscious sedation
Author(s):

Craig David

DOI:
10.1093/med/9780199564217.003.0008
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date: 25 February 2018

Many patients regard all dental treatment, and especially surgical procedures, as potentially painful and stressful. Reactions range from ‘normal’ apprehension, through various degrees of anxiety to irrational fear or even phobia. The adverse physiological effects of these psychological responses can increase the risk of treatment and should be controlled. This is particularly important for patients suffering from medical conditions which are made worse by fear.

Conscious sedation is considered by both the United Kingdom (UK) General Dental Council and the UK Department of Health to be an integral element of the control of pain and anxiety. In other words, conscious sedation is an important aspect of the modern practice of dentistry.

The UK Department of Health defines conscious sedation as ‘A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation should carry a margin of safety wide enough to render loss of consciousness unlikely. The level of consciousness must be such that the patient remains conscious, retains protective reflexes, and is able to understand and respond to verbal commands’.

In the UK, the most commonly used dental conscious sedation techniques (titrated intravenous midazolam or titrated inhaled nitrous oxide/oxygen) have an excellent safety record. For many patients, conscious sedation combined with effective local anaesthesia is a very acceptable alternative to general anaesthesia. Explaining the benefits and risks of local anaesthesia, sedation, and general anaesthesia is an important part of the consent process. Despite the safety, efficacy, and cost-benefits of using conscious sedation techniques there are still indications for general anaesthesia for some dental/surgical procedures and certain patient groups.

This chapter provides an introduction to conscious sedation techniques for dental or oral surgery procedures, patient assessment and treatment planning, essential pharmacology, sedation equipment, clinical sedation (‘standard’ and ‘alternative’), sedation for medically compromised patients, and the avoidance/ management of sedation-related complications. However, before administering any form of conscious sedation the dental team must have received appropriate training in accordance with contemporary professional guidance.

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