SAAD digest
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To investigate the efficacy of the Bispectral Index monitor (BIS) in monitoring patients receiving intravenous midazolam for dental treatment. ⋯ BIS monitoring may be a useful adjunct in monitoring patients receiving sedation for dental treatment using midazolam.
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Midazolam is a benzodiazepine commonly used for conscious sedation in dentistry. This paper reports a state of unconsciousness in a 14-year-old girl after administration of midazolam sedation for dental treatment, which was not reversible with flumazenil. The patient remained in an Intensive Care Unit for two days, unresponsive to any stimulus. ⋯ The patient fully recovered and was discharged from hospital after 6 days. A referral to a sleeping disorder clinic was made to investigate the patient's sleeping patterns. This paper highlights the importance of sedation being provided by an appropriately trained team.
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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.