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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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.