title: Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K.
abstract: BACKGROUND
  Child dental anxiety is widespread, and it is not always possible to treat children using traditional methods such as behavioural management, local anaesthesia and even relative analgesia. In such cases a dental general anaesthetic (DGA) is the only option available to facilitate dental treatment in anxious children.
  
  
  OBJECTIVE
  This study describes an advanced conscious sedation protocol which allows invasive treatment to be carried out in anxious children. It incorporates the use of titrated intravenous midazolam and fentanyl and inhalation agents, sevoflurane and nitrous oxide/oxygen, which is administered by a Consultant Anaesthetist. The aim is to produce an evidence- based study which can offer a sedation technique as a safe and effective alternative to a DGA.
  
  
  METHODS
  Retrospective audit.
  
  
  METHODS
  267 clinical records were audited retrospectively from a specialist sedation-based clinic, for children aged 5-15 years old. The subjects all underwent invasive dental procedures with this technique between August and November 2008 as an alternative to a DGA.
  
  
  RESULTS
  262/267 (98%) of the subjects were treated safely and successfully and without the loss of verbal communication using this technique. This included many treatments requiring four quadrant dentistry, with both restorations and extractions as necessary being carried out in one visit. 5 subjects (2%) did not tolerate treatment and had to be referred for a DGA. No medical emergencies occurred.
  
  
  CONCLUSIONS
  Based on the evidence for this group of patients, this advanced conscious sedation technique, offers a safe and effective alternative to DGA. This technique must be carried out in an appropriate environment by an appropriately trained and experienced team who are able to comply with the recommendations for "alternative" sedation techniques.
authors.affiliation: Department of Child Dental Health, Newcastle Dental Hospital.
authors.forename: Darren
authors.initials: D
authors.lastname: Hand
authors.forename: Paul
authors.initials: P
authors.lastname: Averley
authors.forename: John
authors.initials: J
authors.lastname: Lyne
authors.forename: Nick
authors.initials: N
authors.lastname: Girdler
mesh_terms: D000293:Adolescent; D000766:Anesthesia, Dental; D018681:Anesthetics, General / Q000008:administration & dosage*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D003299:Cooperative Behavior; D016854:Dental Anxiety / Q000517:prevention & control; D019230:Dental Audit; D004244:Dizziness / Q000209:etiology; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012189:Retrospective Studies; D012449:Safety; D000077149:Sevoflurane; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D018681:Anesthetics, General; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl