7
Conscious Sedation
Definition
Conscious sedation is a technique in which the use of a drug or drugs produce 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 technique 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 understand and to respond to verbal commands.
Indications
- Children/adolescents who are anxious but potentially cooperative.
- To supplement LA for:
- potentially traumatic and long procedures, such as multiple extractions and minor surgery;
- where LA alone is not proving to be effective, such as the extirpation of hypersensitive pulps.
- Children who have an anxiety-related pronounced gag reflex.
- To induce a state of relaxation for systematic desensitisation in children with needle phobia.
Preparing for Sedation
An acronym used in the American Academy of Paediatric Dentistry Guidelines (2006) is SOAPME:
S = suction
O = oxygen devices to allow its delivery
A = airway
P = pharmacy: emergency drugs and antagonists like flumazenil (Box 7.1)
M = monitors: pulse
E = special equipment or drugs for a particular case or type of sedation. For intravenous sedation more extensive as indicated (Box 7.2)
Box 7.1 Essential Emergency Drugs that Should be Available
Oxygen
Epinephrine hydrochloride 1:1000 in 1 ml ampoule for IM injection
Hydrocortisone sodium phosphate 100 mg/ampoule
Suitable delivery systems such as needles and syringes
Flumazenil, for reversing oversedation induced by midazolam
Box 7.2 Emergency Equipment that Should Be Available for Sedation
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