4.8 PREPARATION FOR CONSCIOUS SEDATION
4.8.1 Environment
There should be a suitable area where the child can sit quietly before the operation so
that the sedative can be administered and the child monitored while it is taking effect.
As a general rule it is not wise to let children have medication at home as quiet
supervision of the child within the surgery premises is prudent. A journey to the
surgery under the increasing influence of a mood-altering drug is not the most
propitious way of preparing distressed children for treatment. These strictures do not
apply to inhalation sedation or intravenous sedation. However, the facilities suitable
for providing care apply equally to oral, inhalational, and intravenous sedation.
During treatment there must be effective suction equipment and in the event of a
power failure, a mechanically operated backup. Sedated patients often hallucinate or
misinterpret words and actions and so, a chaperone to safeguard the operator-
sedationist is also essential. Once treatment is complete the child should be able to sit
(or lie) quietly until sufficiently recovered to be accompanied home.
A further important strategy is to have a checklist so that the dental surgeon can be
sure that all important elements of sedation have been properly considered.
4.8.2 Preoperative instructions
These should be provided in writing and cover such points as ensuring that a suitable
companion brings the child to and from the surgery, that only a light meal is eaten 2 h
or more before an appointment for sedation. In this context, a light meal is a cup of
tea and a slice of toast. Postoperatively, suitable arrangements need to be in place for
travel and to ensure that the child plays quietly at home. In addition to these specific
points 'local' rules are likely to apply.
Key Points
To carry out conscious sedation:
- informed consent is mandatory;
- preoperative and postoperative instructions should be given prior to the sedation
visit; - patient assessment includes medical, dental, and anxiety history;
- appropriate facilities, child-friendly environment and sedation trained staff are
essential; - the operator-sedationist, irrespective of gender, must be chaperoned at all times;
- the child must be accompanied by an adult escort;
- a checklist is important to ensure all preparations are in place.
4.9 MONITORING THE SEDATED CHILD
4.9.1 Clinical status
Sedative drugs are also central nervous system and respiratory depressants and as
such, cause a variety of effects from mild sedation, deep sedation, and general
anaesthesia and, in excessive concentrations, even death. For this reason, the facilities
outlined above are necessary in the unlikely event of unexpected loss of