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References

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Complications of conscious sedation: causes and management

From Volume 44, Issue 11, December 2017 | Pages 1034-1040

Authors

Tina Halai

BDS, MJDF RCS(Eng)

Specialty Registrar in Oral Surgery

Articles by Tina Halai

Ambareen Naqvi

BDS(Hons), MJDF RCS(Eng)

Specialty Dentist in Oral Surgery, Eastman Dental Hospital, 256 Gray's Inn Road, London WC1X 8LD

Articles by Ambareen Naqvi

Clare Steel

BDS (Manc), MFDS RCS (Edin), M Oral Surg RCS (Eng), PGCert MedEd (Newc)

Specialty Registrar in Oral Surgery, Eastman Dental Hospital, 256 Gray's Inn Road, London WC1X 8LD

Articles by Clare Steel

Sonita Koshal

BDS(Hons), MFDS RCSEng

Consultant in Oral Surgery, Eastman Dental Hospital, 47–49 Huntley Street, London WC1E 6DG, UK.

Articles by Sonita Koshal

Abstract

Abstract: Conscious sedation is a common treatment modality for patients with dental anxiety. In adults, intravenous sedation using Midazolam is the most common method of conscious sedation. For inhalational sedation, Nitrous Oxide and Oxygen are used frequently. Clinicians should be aware of the potential complications associated with delivery of intravenous sedation which can occur pre-, peri- and post-sedation. An awareness of the pharmacology of the drugs as well as careful patient assessment and monitoring can help clinicians to anticipate and reduce complications. This article will review the most common complications and describe prevention and management of each.

CPD/Clinical Relevance: With increasing dental anxiety amongst the population, there may be further potential demand for treatment provision for patients using conscious sedation. This article summarizes management of complications for general dental practitioners to be mindful of, which can occur pre-sedation, during sedation and post-sedation.

Article

In 2009, the Adult Dental Health Survey stated that 12% of adults who had ever attended a dentist reported having extreme dental anxiety based on the Modified Dental Anxiety Scale.1 As dental practitioners, patients often comment on their anxiety or past experiences which they deem as being unpleasant. An alternative option to treating patients with severe dental anxiety under local anaesthesia alone may be through delivery of conscious sedation.

Conscious sedation is defined 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 with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.

The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to respond to verbal commands.’2

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