SAAD digest
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Capnography monitoring during conscious sedation is not currently required for dentistry in Britain and Ireland. Other countries have introduced guidelines and standards requiring capnography monitoring for procedural sedation. ⋯ Standards are generally set from the best available evidence based research. There is a growing body of literature that recognises the potential additional value of capnography (ETCO2) monitoring during procedural sedation in different settings and for different sedation techniques.2-5 In these studies, capnography reduced the incidence of hypoxaemia during procedural sedation. A meta-analysis published by Waugh et al. (2010) concluded that end-tidal carbon dioxide monitoring is an important addition in detecting respiratory depression during procedural sedation.6 A more recent systematic review by Conway et al. (2016) concluded that patients monitored with capnography in addition to standard monitoring had a reduced risk of hypoxaemia compared to those with only standard monitoring.7 However, it has to be noted that both the Waugh and Conway reviews contained substantial statistical heterogenicity which is likely to affect the quality of the evidence. As research evidence for capnography monitoring from the medical settings studied became available, new standards for capnography monitoring were introduced in several countries (Table 1).
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Allergic cross-reactivity between propofol and food is frequently considered as a risk factor for perioperative allergic hypersensitivity reactions and anaphylaxis during dental anaesthesia and sedation. Better understanding of of this cross-reactivity is important to providing safe care. There are, however, conflicting assumptions about anaphylactic reactions to propofol in patients reporting allergy to certain type of the food. ⋯ A literature search was undertaken. The current published evidence does not elucidate that propofol allergy and food allergies are linked directly, but this drug should be used with caution in atopic patients with allergies to egg and/or soya bean oil. Clinical audit projects may gather data on anaphylactic events during anaesthesia and may aid the profession in this dilemma.
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The National Health Service anaesthesia annual activity (2013) was recently reported by the Fifth National Audit Program of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Within a large dataset were 620 dental cases. Here, we describe this data subset. ⋯ Approximately 50% of adults and 16% of children received a tracheal tube: 20% of children needed only anaesthesia by face mask. These data show that anaesthetists almost always use general anaesthesia for dental procedures and this exposes difficulties in training of anaesthetists in sedation techniques. Dentists, however, are well known to use sedation when operating alone and our report provides encouragement for a comprehensive survey of dental sedation and anaesthesia practice in both NHS and non-NHS hospitals and clinics in the UK.
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To review the current teaching of the use and administration of local anaesthesia in United Kingdom dental schools, along with their local guidelines and protocols. ⋯ 2% Lidocaine with 1:80,000 Adrenaline remains the gold standard dental local anaesthetic with teaching about its safety and uses in all but a few situations. Most are taught the use of additional aids such as safety syringes and topical anaesthesia. There is variation with regards to the use of alternative anaesthetic agents.
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Conscious sedation is an integral part of modern day dental care and should be delivered through a high quality, effective and evidence-based approach. Commissioning of NHS dental services in England is currently under review by NHS England and the National Dental Commissioning Group. This group has identified the management of vulnerable people including anxious patients, as one of its priorities. ⋯ Its ethos is a"hub and spoke" model of service delivery with patient assessment delivered by experienced and well trained dental sedationists at its core. In line with the recent Francis Report fundamental standards for all aspects of dental conscious sedation practice are outlined, supported by a robust and predictable quality assurance process. This work has been shared with key stakeholders in NHS England including the Chief Dental Officer and the Head of Primary Care Commissioning.