working on children. Current developments in intravenous techniques, especially the
use of target-controlled infusion pumps and patient-controlled sedation (PCS) may
prove to be sufficiently effective and safe for use by the operator/sedationist, but
further research is required.
Key Point
- The goal of conscious sedation is to use a pharmacological agent to augment
behavioural management to decrease anxiety levels while maintaining a responsive
patient.
4.7.1 General facilities
The use of sedative drugs carries the risk of inadvertent loss of consciousness.
Although the techniques are designed to reduce this risk to a minimum it should
always be borne in mind that every time a sedative is given to a patient there is a risk
of an idiosyncratic reaction to the drug, which may result in hypoxia or unexpected
loss of consciousness. The clinician must arrange the clinical session so that sedation,
irrespective of complications, can proceed smoothly and safely. This includes the
need for all patients who are having sedation to be accompanied. This can be any
adult, who understands the implications and potential problems of caring for a child
during the later stages of recovery. In addition, the clinical facilities need to include
suitable resuscitation equipment coupled with the knowledge and skills to use them.
Key Points
- The main complications related to paediatric conscious sedation are:
-hypoxia,
-nausea,
-vomiting,
-inadvertent loss of consciousness (general anaesthesia/over sedation). - Morbidity and mortality increase with:
-young age,
-worsening ASA classification.
4.7.2 Emergency equipment
Suitable emergency equipment must be available easily to hand since time is of the
utmost importance. For this reason emergency equipment and drugs should be within
arms reach of the operator and ready for immediate use. Training of the dental team
is a requirement, irrespective of whether conscious sedation is practised. Training
should be updated at regular intervals of not more than 1 year. It is essential that each
member of the dental team knows exactly what is required of them in an emergency.
The dental surgeon has the responsibility of ensuring the easy availability of drugs,
particularly oxygen, and to see that the drugs in the emergency kit are not past their
'use by' date.
4.7.3 Emergency equipment for the dental surgeon
The following are items of equipment that a dental surgeon should be prepared to use
in an emergency.