Equipment Continued »
for four cylinders; two oxygen and two nitrous oxide: ‘E’ size with pin indexed fittings to prevent interchange of gases.
Scavenging of waste nitrous oxide This is a vitally important subject and attention to detail should be exercised when choosing the correct system for indi- vidual application. There are two distinct areas of scavenging: • Scavenger breathing system (or patient delivery circuit)
• Method of active removal of waste gases from surgery environment. Scavenger breathing systems: All Dental
breathing systems should be active – the definition of which is: “An air flow rate of 45 L/min.” This is designed to comply with the COSHH exposure limit of ı00 ppm over an eight-hour TWA (Time Weighted Average). Most current manufacturers produce a breathing system that complies with this. Porter offers both the Porter brown and ANS (Autoclavable Nitrous Scavenger) systems and Accutron also produces a version of this type of system. The efficiency of these systems varies
slightly depending on whether a single or double mask is used – the double mask being more efficient at scavenging as determined by various studies. The most well recognised of which is: Clinical evaluation of the efficacy of three nitrous oxide scavenging units during dental treatment4. This study concludes that the Porter brown double mask breathing system is the most efficient.
Methods of generating extraction flow rate: There are only three methods available: 1. Connection to a suitable dental vacuum system – using the high volume port (subject to it being externally vented and also capable of sustaining the 45 L/min draw during the sedation procedure)
2. Connection to a centralised anaesthetic gas scavenging system – directly to the terminal by a special AGS probe adapter – but with no air break in-line
3. Connection to a Miniscav – stand-alone dedicated scavenger unit.
Maintenance Once you have your equipment, it is strongly recommended that regular
maintenance is carried out. Guidelines can be vague however, the document Commissioning conscious sedation services in primary dental care Annex ı checklist5 states that it is mandatory to have the equipment serviced according to the manu- facturer’s guidelines. The generally recognised
service interval in the UK is once per annum. This ensures equip- ment is kept in optimum working order including calibration.
REFERENCES
1) ‘Standards in Conscious Sedation in Dentistry’. Report of an Independent Expert Working Group, Oct 2000
2) ‘Conscious Sedation in the Provision of Dental Care’. Report of an Expert group on Sedation for Dentistry Department of Health, 2003
3) Health Technical Memorandum 02-01 Part A: design, installation, validation and verifica- tion. Department of Health 2006 4)‘Clinical evaluation of the efficacy of three nitrous oxide scavenging units during dental treatment’. Certismo, Walton, Hartzell, Farris General Dentistry, September-October 2002 5)‘Commissioning conscious sedation services in primary dental care’. Department of Health, May 2007.
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Scottish Dental magazine 57
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