Sedation
and cry. Parents are advised in advance to expect this. Despite the low volume of drug being given, some of this can run into the patient’s oropharynx and it can taste unpleasant. Combining midazolam with lignocaine helps minimise any discomfort from intra nasal admin- istration. Onset of action takes approxi-
mately ı0 minutes. Oxygen saturation and heart rate are moni- tored throughout treatment until discharge from recovery. Dura- tion of sedation is between 30-45 minutes, allowing most routine treatment to be undertaken on child patients. The degree of sedation can be variable, particularly in child patients, and restlessness is more common than with adult IV seda- tion. Intra-nasal midazolam results in retrograde amnesia, helping patients to forget or have little memory of their treatment. The combination of intra-
nasal midazolam with inhalation sedation is considered to be an
advanced form of sedation by SAAD and should be restricted to those with postgraduate training in sedation. At Clyde Dental, a sedationist separate from the operating dentist is used. As with other forms of sedation, intra-nasal is not a replacement for general anaesthesia. Patients must be willing to co-operate and accept the need for dental treatment. Intra-nasal sedation provides another option to help manage anxious patients. In summary, the use of intra-nasal
midazolam is clearly shown in the literature to be a highly effective method of sedation. However, it is essential that practitioners using this advanced technique undertake an adequate level of training. Cases should be carefully selected in order to achieve a high level of success with this technique. Sedation should be used in conjunction with effective communication and non-pharmaco- logical behaviour management techniques.
“Cases
should be carefully selected in order to achieve a high level of success with this technique”
ABOUT THE AUTHOR
Clive graduated from Glasgow University in 1993 and is currently a partner at Clyde Dental Practice, Ivy Cottage Dental Practice and Commonwealth Dental Practice. He has been very active in post-grad- uate education, having achieved the following qualifications: DGDP(UK) 1996, MGDS(Glas) 1999, FFGDP(UK) 2002, Diploma in Conscious Seda- tion (Newcastle) 2004, Diploma in Implant Dentistry RCS 2007 and Fellowship in Dental Surgery (RCS Ed) 2011.
He is a visiting GDP supervising undergraduates in the restorative department at Glasgow Dental School, teaches on the Scottish Dental Implant Year Course and lectures on CBCT in dental practice. He was previously a diploma tutor for the West of Scotland MFDGP(UK)/MJDF study group and remains involved with the FGDP(UK).
His practices welcome patient referrals for restorative and oral surgery under conscious seda- tion (intravenous and inhalation). Clive accept referrals for implant dentistry including bone grafting and sinus augmentation.
Scottish Dental magazine 53
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