Sedation
To sedate or not to sedate
A sneak peak into the world of sedation by one of Ireland’s leading consultant anaesthetists Dr Michael Carey
S
edation in dentistry is nothing new – sedation has been used in dentistry since the ı840s. However, things have moved on a lot since then. In
the past, dental treatments were simpler and mainly consisted of fillings or extrac- tions/dentures. Now, treatment is more complex and can take a long time, so patients can spend a lot more time in the chair and therefore want minimal discomfort. With increased awareness that sedation is available, dentists are starting to provide the service more and more themselves. Sedation works best when combined
with adequate local anaesthesia – the patient is pain-free, relaxed and has no memory of the procedure. The dentist can work more efficiently under these conditions, and it leaves a patient more comfortable and happy to return to the dentist. However, sedation can go wrong. This
can occur in endoscopy units where a single operator does both jobs. The oper- ator could potentially give a relatively high dose while concentrating on the procedure, not the patients’ oxygena- tion. The presence of an anaesthetist is optimum in these situations. Michael Jacksons’ death is a classic
example of what can happen when the patient is not monitored and when the operator doesn’t have the skills, experi- ence or equipment to get out of trouble. The Northumberland Institute is an
example of best practice and adheres to the strictest safety regimes, which I insist on; there must be oxygen, airway management equipment, drugs to deal with cardiorespiratory arrest and anaphylactic shock, and a defibrillator. Everyone in the surgery has a
28 Ireland’s Dental magazine
current Basic Life Support certificate from the Irish Heart Foundation. This, on top of an extra nurse present when the patient is in the chair, is all a significant investment
for any dental practice. Finally, I think the minimum require-
ment is that there should be two people involved – the dentist and the sedationist. No condition totally rules out sedation
in the dental chair. However, overweight and elderly patients, or those with signifi- cant medical problems ought to be treated in a surgery which provides more inten- sive monitoring and after care; a general
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