Volume 24 - The Society for the Advancement of Anaesthesia in ...

SDAC GUIDELINES
REVIEW OF GUIDANCE FROM
THE STANDING COMMITTEE ON SEDATION
FOR DENTISTRY 2007
Michael Wood
This guidance is an important document that was
commissioned by the Chief Dental Officer (CDO),
Dr Raman Bedi, following a serious sedation incident
involving a healthy six-year-old boy in Cambridge in 2004.
Professor John Lowry convened a group of experts
in sedation and formed the Standing Committee on
Sedation for Dentistry, which initially reported to the
Standing Dental Advisory Committee (SDAC), and
thereafter the work was continued as a joint Faculty
of Dental Surgery and Royal College of Anaesthetists
document. The group first met in February 2005 and the
document has only now seen the light of day.
The SDAC were asked to develop a strategy and make
recommendations on:
• More rigorous maintenance of safety and quality standards
for conscious sedation in the provision of dental care.
• Improving access to more effective services for pain and
anxiety control by delivering appropriate techniques
matched to individual patient needs in a timely manner
at a convenient location.
Standards for Conscious
Sedation in Dentistry:
Alternative Techniques
A Report from the Standing Committee on Sedation for
Dentistry, 2007
• The definition of Conscious Sedation remains
unchanged.
• There remains disquiet about safety and quality
standards in the provision of sedation for dental care.
This applies particularly to the use of more advanced
techniques + extending beyond the basic techniques*
described in Conscious Sedation in the Provision of Dental
Care (Standing Dental Advisory Committee) 2003.
There are nevertheless examples of good practice in
the safe and effective administration of alternative
techniques by well trained and experienced teams
working in tightly controlled clinical settings.
• This document develops the earlier guidance to
encompass the use of alternative sedation techniques. It
has been prepared for dental and medical practitioners
including anaesthetists and their teams. The combined
guidance is designed to enable practitioners to take
appropriate steps in the provision of a minimum
standard of conscious sedation to supplement local
anaesthesia for safe and effective patient care whatever
the clinical setting.
• Standard and Alternative Sedation Services are
defined:
Standard techniques are:
• inhalational sedation using nitrous oxide/oxygen
• intravenous sedation using midazolam alone
• oral/transmucosal benzodiazepine* provided adequate
competence in intravenous techniques has been
demonstrated.
*The transmucosal administration of conscious sedation is
regarded by some sedationists as falling within the category
of standard techniques. Nevertheless it is essential that strict
protocols are in place. See Annex 4.
SAAD DIGEST | VOL.24 | JANUARY 2008 39