There are several agents available that are being commonly used for sedation. However with newer agents coming everyday, there is a bit of confusion. Please provide your inputs and the reasons for preferring one agent over another.
its better not to use sedation in dental clinics without anesthetist present. even with anesthetist present some cases of death of child patients have been reported. it is better to put children under sedation in hospital setting only. its safer and more efficient to handle any emergencies that may occur.
Intra venous Concious Sedation by a certified Anesthetist ..for a uncooperative child and keep the procedure short ..say..45mins- 1 hour .
procedures demanding more time.is always recommendable to post under GA.
inhalation sedation is better than other form ,Nitrous oxide sedation is very safe ,effective ,nitrous oxide sedation is even safe in medically compromised children ,we can tit-rate inhalation sedation , Nitrous oxide sedation is absolute safe ..
Midazolam can be administered orally or rectally to small children in a normal dental Office. As Long as no dental pain or serious infections are present, temporary treatment with fluorides is to prefer before sedation.
I have had good success with LIGHT triazolam, Halcion, given orally in the office an hour prior to the appointment. We crush up the tablet with jelly. Small doses, 0.125 mg. The child will be awake, and may make some noise but they remember nothing. You must keep them in the office long enough to be sure they will not fall asleep and occlude their airway on the way home in a car seat. They come an hour early, you can do dentistry for about an hour. You keep them in teh office for 2 additional hours to be sure they are safe to leave. You must be trained to rescue if a child got too deep. Have the reversal agent and be able to open an airway and rescue breath. I never needed to, but you must be trained and current in these techniques. If you reverse the drug they must be with you for at least 4 hours to be sure they do not rebound as the reversal agent is metabolized.
Moderate sedation can be successfully used in the clinical management of paediatric dental patients, with both intranasal and oral sedation using midazolam in conjunction with/without nitrous oxide. These methods can be used safely and effectively when administered by a paediatric dentist who follows the sedation guidelines and specialized on dental sedation. If you work in your private dental office, it will be better for you to work with anaesthesiologist.
Nasal administration of midazolam is extremely painful. Therefore we prefer oral administration.
Midazolam is relatively quickly out of the system, there are no problems with addiction and the risk of an overdose is small if handled with common sense.
Interestingly, the recent study published in BDJ (Nov 2014) demonstrated that sevoflurane (gas uses for medical GA induction and maintenance) was found to be as effective as an inhalation sedation agent as the standard dose of nitrous oxide used in routine inhalation sedation in the treatment of adult anxious dental patients.
Sevoflurane in low concentrations is equivalent in effect to similar concentrations of nitrous oxide.
(Allen M, Thompson S. “An equivalence study comparing nitrous oxide and oxygen with low-dose sevoflurane and oxygen as inhalation sedation agents in dentistry for adults”. British Dental Journal 217, E18 (2014).
Bear in mind the mixed techniques, such as intranasal pre-sedation with Midazolam and standard N2O/O2 inhalation sedation. However, it should not be a routine method, but rather a special case technique in very individual cases.
I prefer Nitrous Oxide sedation with uninterrupted Oxygen inflow.
I prefer Nitrous Oxide sedation with uninterrupted Oxygen inflow.
I prefer Nitrous Oxide sedation with uninterrupted Oxygen inflow.
I prefer Nitrous Oxide sedation with uninterrupted Oxygen inflow.
I prefer Nitrous Oxide sedation with uninterrupted Oxygen inflow.
intranasal pre-sedation with Midazolam and standard N2O/O2 inhalation sedation. However, it should not be a routine method,
- Badges
- Science topic
- Similar topics
- Chemistry
- Pharmacology
- Medical Pharmacology
- Clinical Pharmacology