PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

This involves alert clinical monitoring and at least the use of a pulse oximeter.

4.10.2 Clinical technique

The following regimen, using the example of diazepam, was found to be effective in
clinical practice:

(1) on arrival of the patient check whether, preoperative instructions have been
followed;
(2) weigh the patient and estimate the dose of diazepam;
(3) have the dosage checked by a second person;
(4) administer diazepam ~1 h before the treatment;
(5) allow the patient to sit in a 'quiet' room;
(6) once ready, start and complete the treatment with (or without) local anaesthesia;
(7) once the treatment is complete, allow the patient to recover in the quiet room until
ready to return home;
(8) reiterate the postoperative instructions to escort.

4.11 INHALATION SEDATION

4.11.0 Introduction

This is synonymous with inhalation of an oxygen-nitrous oxide gas mixture in
relatively low concentrations, usually 20-50% nitrous oxide. The technique is unique
as the operator is able to titrate the gas against each individual patient. That is to say,
the operator increases the concentration to the patient, observes the effect, and as
appropriate, increases (or sometimes decreases) the concentration to obtain optimum
sedation in each individual patient.

Inhalation sedation consists of three elements (Fig. 4.2):

1. The administration of low-to-moderate concentrations of nitrous oxide in oxygen to
   patients who remain conscious. The precise concentration of nitrous oxide is carefully
   titrated to the needs of each individual patient.


2. As the nitrous oxide begins to exert its pharmacological effects, the patient is
   subjected to a steady flow of reassuring and semi-hypnotic suggestion. This
   establishes and maintains rapport with the patient.


3. The use of equipment that exceeds the current BSI Standard for safety cut-out
   devices installed within inhalation sedation equipment. This means that it is not
   possible to administer 100% nitrous oxide either accidentally or deliberately (the cut-
   off point is usually 70%). This is an important and critical clinical safety feature that
   is essential for the operator/sedationist.