S.M.A.R.T. Dental Nursing Sedation
Also see chapter Advanced Dental Nursing

Allow patient to recover in a quiet environment.

Patient must be under observation until fully recovered.

Recovery area should be equipped to an appropriate standard.

BP recorded
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At least I hour should have elapsed since the last increment drug was administered

Venous cannula left in situ until patient ready for discharge

Must be able to stand and walk without assistance

Discharged into the care of their escort

Both patient and escort should be given verbal and written post-operative instructions
Negative EVE test Accurately touch tip of nose with index finger
Rhomberg’s test Patient able to stand with eyes closed without undue swaying
Cannula removed with pressure over site to prevent haematoma
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
Extravascular Injection

Intra-arterial Injection

Haematoma

Pain of Cannulation

Ru le of P’s ( perfect preparation + positioning avoids piss poor performance!)
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Check the drug for date expiry.

Always label the syringe as soon as you have drawn up the drug.

( Colourless liquids look the same in a syringe.)

Dispose of unused drugs in the approved manner.
Hyper-response

Rapid sedation 1 - 2 mg.

Beware the elderly patient
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Interaction with Alcohol & CNS depressants

Rare in younger patients

Emphasizes need for careful titration
Over
– Sedation

Misjudgment of patient dose

Too rapid administration

Failure to interpret patients signs
 Verril’s sign - too deep ( if using midazolam )

Failure of communication - learning difficulty

Respiratory Depression occurs first

Loss of Consciousness
Management of Over – Sedation

Monitor patient and readings

Maintain communication

Mild - encourage deep breathing

More severe - Supplemental oxygen
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
Look for signs of obstruction and correct

Reversal with Flumazenil

Monitor patient for re-sedation
Hypo-response

Higher than normal dose with little effect

High tolerance for benzodiaepines

Check cannula in blood stream

Normal maximum 7.5mg

No more than 2 ampoules - 20mg

Requires GA
Rapid Recovery

After 10 - 15 minutes becoming restless

Normally 30 - 40 minutes of time

Top up using 1 - 2 mg at a time

Maximum total dose - 2 ampoules
Paradoxical Reactions

Disinhibition - Talkative or Weepy

Sedate normally but become very distressed with treatment.

Needle phobic in the mouth

Hyper-reaction to the noise of the drill

Must distinguish from a poor LA

Requires GA.
Other side effects
Hiccups
May persist for up to 30 minutes. Appears to be associated with excessive or too rapid injection.
Sexual Fantasy
Ensure that no sedated ( or recovering ) patient is left alone with only one member of the dental team
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
Incorrect assessment

Unrealistic expectations

Anxyolsis is not oblivion

Missing the window

Poor LA

Treatment plan not appropriate
 ‘ Bad sedation ’ day patient or dentist out of sorts that day
patient kept waiting pre-op
Managing failure

Be aware - quit whilst ahead

Be flexible - consider alternative sedation techniques

Be positive, be honest to patients

Refer for GA or to Specialist Sedation Clinic
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