Is intravenous conscious sedation for surgical orthodontics in children a viable alternative to general anaesthesia?--a case review.
OBJECTIVE
The aim of this case review was to describe the use of local anaesthesia (LA) and intravenous conscious sedation (IVCS) as a safe and effective means of managing patients requiring surgical orthodontic procedures as an alternative to general anaesthesia (GA) in children between the age of 11 and 15 years.


METHODS
1) Whether treatment was completed, partially completed or not completed; 2) assessment of physiological parameters to verify safety profile of the technique.


METHODS
Records were reviewed retrospectively for all patients included in the series undergoing planned surgical orthodontic procedures between January 2001 and January 2004 under IVCS. All patients had been pre-assessed and deemed to be of sufficient mental and physical maturity to be treated with IVCS. Written informed consent was gained from patients and their parents/guardians with full discussion of the alternative pain and anxiety control methods available including GA. All cases were undertaken by experienced SAS grade surgeons assisted by two dental nurses holding the certificate in dental sedation nursing and their recovery was supervised by registered general nurses. Patients were clinically monitored throughout together with continuous pulse oximetry and intermittent recording of non invasive blood pressure and pulse at 10-15 minute intervals. Patients were reviewed post operatively and any complications or comments noted.


RESULTS
Over a three year period a total of 107 patients underwent surgical procedures to aid orthodontic treatment, 28 (26%) under IVCS and 79 (74%) under GA. Twenty-five out of 28 patients in the IVCS group successfully completed all of their planned treatment.


CONCLUSIONS
Based on this case series, IVCS would appear to offer a safe and effective alternative to GA for this group of patients providing they are selected and managed by an appropriately trained team in a suitable setting. Further prospective evidence is needed if IVCS is to be recommended for general dental treatment in patients under the age of 16 years.
Dorman
M L
ML
Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Sunderland, UK. mattdorman@blueyonder.co.uk
Wilson
K
K
Stone
K
K
Stassen
L F A
LF
D000293:Adolescent; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General; D000772:Anesthesia, Local; D018686:Anesthetics, Intravenous; D002648:Child; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D016854:Dental Anxiety / Q000517:prevention & control; D019140:Dental Care for Children; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000601:surgery*; D008874:Midazolam; D019647:Oral Surgical Procedures; D012189:Retrospective Studies; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000601:surgery; D006113:United Kingdom
D018686:Anesthetics, Intravenous; D008874:Midazolam