Conscious sedation

CONSCIOUS SEDATION

Prince Dhingra B.D.S. Final YearJ.C.D. Dental CollegeSirsa(Haryana)

CONTENTS • INTRODUCTION• What is Conscious Sedation• Objectives of Conscious sedation• Indications• Routes used for conscious sedation• Drugs used for conscious sedation• Monitoring• Nitrous Oxide and phases of its administration• Fasting Guidelines• Contraindications• Adverse Effects

• A minimally depressed level of consciousness, that retains patient’s ability to maintain an airway independently and respond appropriately to physical stimulation and verbal command. {ADA(1993)}

Definition of Conscious Sedation

Reference From: Illustrated Paedriatic Dentistry By PR Chockalingam

Objectives Of Conscious

Sedation

Vital Signs stable and

normal.Patient should be

cooperative.

Patient should be conscious,

respond to verbal stimuli.

The patient’s mood should be

altered

Amnesia should occur.

Child’s pain threshold should be increased

All protective Reflexes intact

Indications

UNCOOPERATIVE

PATIENT

Patients with lack of

pschychological or emotional

maturity.FEARFUL AND

ANXIOUS PATIENT

Routes used for conscious sedation

EnteralParenteralTransdermalTransmucosalInhalation

Drugs used for conscious Sedation

• Nitrous oxide and oxygen mixture

• Fentanyl• Diazepam• Propofol• Midazolam

Monitoring Oxygen saturation must be evaluated by

pulse oximetry The Dentist must monitor ventilation and/or

breathingBlood pressure and heart rate must be

evaluatedE.C.G. monitoring

Nitrous Oxide and OxygenNitrous oxide is most commonly used drugbecause of its rapidity of onset and the rapidityof recovery.It has 4 phases of Administration;

Phase Objectives/Events Gases Administered at relative Analgesia

Induction Phase Introduction, explanation and instructions of the procedure

100% Oxygen,3-5 L/min for 3 minutes

Injection Phase

To obtain sedation while suggesting positive thoughts

•Rapid mode:21/2 Litre each of N2O2 and O2 for 6-8 minutes •Slow mode:0.5 L of N2O2 with an incremental increase of 0.5 L to a level of 21/2 L with a corresponding decrease in oxygen for 11 to 13 minutes.

Maintenance Phase

Maintain the depth of sedation and state of analgesia.

1-2 litre of Nitrous Oxide and 3-4 L of oxygen(25:75-40:60 concentration)

WithdrawalPhase

Obtain complete recovery. 100% oxygen for 3-11 minutes,5 L of oxygen per minute

INDUCTION PHASE

INJECTION PHASE

MAINTENANCE PHASE

WITHDRAWAL PHASE

Fasting Guidelines given by American Society Anaesthesiologists

INGESTED MATERIAL MINIMUM FASTING PERIOD

Clear Liquids 2 hoursBreast Milk 4 hours

Infant Formula 6 hours

Nonhuman milk 6 hours

Light Meal 6 hours

Fatty Meal 8 hours

Contraindications

Dental difficulties, prolonged

surgery, inadequate personnel.

Unwilling, unaccompanied

patients.

Chronic obstructive pulmonary

disorder(COPD), pregnancy,

myasthenia, epilepsy, obesity,

bleeding disorders.

CONSCIOUS SEDATION GENERAL ANAESTHESIAAt several visits the procedure may be performed

Generally a single sitting, once in a lifetimeProcedure

Patient is cooperative, but anxious and fearful

Patient is uncooperative

Generally no extensive investigations are required No premedication is required either

Atleast basic investigations are a mustPremedication is also required

Patient is conscious and contact is maintained

Ventillation is required

Airway is maintained

No mortality 99% success rate reported

Recuperation period is 1-2 minutes Time Consuming procedure

Patient feels he is in control of the situation

Patient cannot control the situation

Nausea and

Vomiting

DiffusionHypoxia

AdverseEffects

ConclusionNitrous oxide and oxygen is a safe and effectivetechnique to reduce anxiety, produce analgesiaand enhance effective communication betweenPatient and operator. It increases patient’s painthreshold. It must be used in pediatric patientand uncooperative patient.

REFERENCES• Dentistry for the Child and Adolescent

by McDonald,Avery,Dean• Textbook of Oral and Maxillofacial

Surgery by Daniel M. Laskin • Essentials of Pharmacology for

Dentistry By KD Tripathi• Illustrated Paedriatic Dentistry By PR Chockalingam