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Successful Pre-Sedation Assessment

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The delivery of conscious sedation within dentistry has long been associated with an excellent safety record. Careful pre-sedation assessment not only aids the optimization of patient care and safety but also is the foundation in the provision of effective sedation. The assessment process is multifactorial and the aim of this essay is to identify the factors, which are of most importance in the assessment of a patient undergoing conscious sedation. Assessment of dental anxiety The determination of the nature, reason for and degree of a patient’s dental anxiety is vital component of any sedation assessment as it can determine the type of sedation undertaken. Within the literature the indicator of sedation need (IOSN) has been reported…show more content…
This not only influences the type of sedation offered but also the setting in which any treatment is undertaken. One of the most commonly employed means of assessing fitness for sedation is the American Society of Anaesthesiologists (ASA) classification7. The system is widely used and helps to identify medical conditions that may influence sedation management. There is some evidence to suggest that there can be issues with regards to inter-examiner reliability and reproducibility of results. Sankar et al. under took a retrospective cohort study looking the reliability of ASA classification in clinical practice 8. The study included a large sample cohort of patients, however some limitations in the evidence where the lack of blinding of the assessing anesthetists therefore introducing a potential source of bias. Furthermore, a large proportion of the patients assessed fell into the ASA II and III categories, therefore the case mix is limited and could be problematic in generalizing the findings. Similarly the proposed evidence that the ASA classification demonstrates, moderate inter-examiner reliability, is also reinforced in a further two studies 9, 10. Interestingly both of the studies identify the ASA classification as a useful tool in assessing patient fitness for sedation or anaesthesia and perioperative risk. However both of these latter studies were…show more content…
Furthermore, it is also important to record a baseline measurement of including heart rate, respiratory rate and oxygen saturation. Firstly this information can help to determine whether or not a patient is fit for sedation, type of sedation and which setting is most suitable for the provision of care. Adverse effects both haemo-dynamically and respiratory can occur with administration of sedation. Malviya et al. presented a large-scale prospective study looking at respiratory events during sedation, and found increased adverse sedation related events occurred within with ASA classifications of III, and IV 19. Comparable results where also noted by Hertzog et al. who looked at propofol sedation in pediatric patients
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