PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

1. The patient's medical history is checked.


2. The arm is extended and a tourniquet applied.


3. The pulse oximeter is applied to the contralateral arm. Note: a very anxious patient
   might be distressed by these procedures so they can be left until the patient is sedated.


4. The venflon is inserted into the vein and taped into place.


5. The patient is asked to touch the tip of the nose to demonstrate good neuromotor
   control.


6. The first dose of drug is administered over 30 s (Fig. 4.10).


7. The patient's response is assessed after 2 min to determine whether further
   (smaller) increments of the sedative agent are required.


8. Dental treatment is carried out. If sedation becomes inadequate further increments
   of the sedative agent may be given.


9. Once dental treatment is complete, the patient is allowed to recover sufficiently to
   be helped to the recovery area.


10. Recovery must be under the supervisory eye of a specially trained personnel.


11. Once the patient is 'street fit', they are discharged into the care of an
    accompanying adult.


12. Postoperative instructions are reiterated.

Monitoring during intravenous sedation

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

Fig. 4.10 Intravenous administration of

midazolam through a vein in the dorsum

of the hand.

4.12.4 Unexpected loss of consciousness

On the rare occasions when the patient becomes unconscious the dentist and their