CONTRAINDICATIONS AND PREPARATIONS FOR CONSCIOUS SEDATION

[Anonymous]

Contraindications
There are few absolute contraindications for Conscious Sedation. However relative
contraindications are important and can only be considered following a thorough
assessment of the patient which only thorough assessment provides. Especial care is
required in the assessment and treatment modality selection for children and elderly
patients. Only patients in ASA classes I and II should normally be considered suitable
for sedation as outpatients 21. Patients in ASA class III should be referred to an
appropriate secondary care unit.

Preparation of Patients
Patients during preparation for Conscious Sedation must receive careful verbal and
written instructions regarding its effects and their responsibilities both before and
immediately after it.

Fasting for Conscious Sedation is not normally required. Patients should generally
be advised to take only light food and clear non-alcoholic fluids prior to an appointment
for Conscious Sedation. However some authorities recommend the same fasting
requirements as for general anaesthesia in view of the potential for depression of upper
airways reflex sensitivity
It is important there is a clear understanding that Conscious Sedation must under no
circumstances be interpreted as light general anaesthesia.
Specific written valid consent must be obtained for all patients who are to receive
treatment under sedation.
A responsible adult escort must accompany the patient home or to a suitable
place of care after treatment under Conscious Sedation and assume responsibility for
the post-sedation care for the rest of the day. The provision of Conscious Sedation may
therefore be unsuitable for a patient who lives alone or who solely cares for children,
elderly and / or dependent relatives. Both patient and escort must understand and
accept that this responsibility is delegated to the escort and both must agree to comply
with this. It is therefore essential that each of these individuals clearly understand the
effects of sedative agents before arriving for the procedure and the consequences of
failing to follow all post-sedation instructions.
Wherever possible there should be arrangements in place for the patient and escort to
travel home by private car or taxi rather than public transport. If this is not possible the
escort must be made fully aware of the added responsibilities of caring for the patient
during the journey home. If either the patient or escort appear to be unwilling or unable
to comply with these requirements Conscious Sedation should not be administered.
For an adult receiving nitrous oxide / oxygen inhalation sedation this requirement is less rigid and each patient must be assessed individually.

        

[drmittal]

4 stages of sedation in dentistry to make you comfortable even before you walk into a dentist’s..

Sedation in dentistry is widely used today in various procedures ranging from an anxious patient to reconstructive surgery. Many procedures require both, anesthesia and sedation to ensure optimum comfort and numbing, and may be administrated intravenously, through an inhalation mask, or orally. It is important to understand the difference between dental anesthesia and dental sedation: anesthesia removes pain, whereas sedation relieves stress or anxiety and affects consciousness. Depending on how much pain you are likely to incur or your personal anxiety level, your dentist will discuss an appropriate stage of dental sedation for you.

There are four stages of sedation in dentistry:

• Light Sedation – to give you a relaxed or calm sensation that soothes anxiety. Usually induced by chemical compound nitrous oxide (N2O) before the procedure in any form mentioned above.

• Medium Sedation – also induced by N2O and often referred to as “conscious sedation in dentistry” because this amount of sedation affects your consciousness, causing you to flitter in and out, while still able to follow the dentist’s instructions. This form of sedation may also be administrated in the same way as mentioned above.

• Deep Sedation – this third stage also affects your consciousness but a larger dose means more time unconscious and less cooperation following dental instruction. This may be deemed appropriate if the procedure (or if your dentist decides) your assistance is not essential and pain will be substantial. Usually intravenously induced.

• Sleep Sedation / IV Sedation – is the most advanced form of sedation in dentistry. This stage uses intravenous drugs to induce a complete sleep through the procedure (no matter how lengthy or complex) without any awareness, anxiety, memory, pain or discomfort.
Some patients have severe cases of dentist phobia where even routine visits seem terrifying while others experience less extreme stress. Thanks to sedation in dentistry – you can ascertain your personal amount of anxiety and decide with your dentist what would be an appropriate level of sedation for you. It is also essential to discuss any health conditions you may have that may be aggravated by sedation or if you are currently taking any other medications that may interfere.

        

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