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Conscious sedation is a technique whereby patients undergo a drug-induced depression of their consciousness but retain the ability to self-ventilate, maintain protective reflexes, and respond to verbal or light-pressure stimuli. Dentists primarily use conscious sedation in managing and treating anxious patients, but it is also valuable for specific comorbidities, namely those associated with dyskinesia or exacerbated by stress. Common techniques employed are inhalation sedation using nitrous oxide/oxygen, oral sedation using diazepam, and single-drug intravenous sedation using midazolam. Nitrous oxide is a colorless, odorless gas and an effective analgesic/anxiolytic agent. Diazepam and midazolam are both in the benzodiazepine class of medications. This activity will highlight the indications, contraindications, equipment, mechanism of action, and techniques for conscious sedation in dentistry, pertinent for interprofessional team members in managing patients with dental anxiety or a clinical need for sedation. Objectives: Describe the indications for using conscious sedation in dentistry. Identify the contraindications for using conscious sedation in dentistry. Summarize the equipment and personnel required for conscious sedation used in dentistry. Explain how to perform the common techniques for conscious sedation used in dentistry. Access free multiple choice questions on this topic.

Conscious sedation is a technique whereby patients undergo a drug-induced depression of their consciousness but retain the ability to self-ventilate, maintain protective reflexes, and respond to verbal or light-pressure stimuli. It is a valuable tool often used in dentistry due to its anxiolytic effects. It makes treatment accessible to nervous patients or those with medical requirements, increasing their cooperation and enabling the practitioner to complete complex treatment without rendering the patient unconscious. Conversely, a general anesthetic is where the patient is unconscious and unresponsive. Respiratory support is, therefore, essential to maintain the airway.[1] Local anesthetic (LA) controls loco-regional pain but does not affect consciousness. Conscious sedation is anxiolytic but does provide adequate analgesia, so LA must also be used.[2] Benzodiazepines, nitrous oxide gas, opioids, ketamine, and propofol are drugs used to provide conscious sedation. Their routes of administration include intravenous, intranasal, oral, and inhalation.[3] Common combinations utilized by dentists are: Inhalation sedation using nitrous oxide/oxygen Oral sedation using diazepam Single-drug intravenous sedation using midazolam

Inhalation Sedation with Nitrous Oxide/Oxygen In general, adverse effects or serious complications are rare. Examples are: Vomiting or nausea Laryngospasm Diffusion hypoxia Nitrous-oxide-induced vitamin B12 inactivation[19] Intravenous sedation with midazolam: Potential Complications Nausea and vomiting Transient desaturations Paradoxical reactions Dizziness Drowsiness Hiccough Hallucinations Respiratory depression[20] Oral Sedation with Diazepam As diazepam and midazolam are the same drug class, their potential complications are similar. They would be less likely in oral sedation due to the route of administration.

Conscious sedation often requires an interprofessional approach to achieve the best outcome for the patient. It is less expensive than general anesthesia, which is very costly as it requires a hospital setting, specialist nurses and theatre staff, etc. In some countries, such as the United Kingdom, it is against the law to perform general anesthesia within a dental practice setting. Therefore, providing treatment under sedation in an outpatient setting can reduce the financial burden on healthcare organizations. Anesthesia or dentists trained in advanced techniques can provide poly-pharmaceutical sedation, allowing the treating dentist to focus on the required procedure.[23] The dentist can prescribe oral anxiolytics at their initial consultation appointment for the patient to collect from a local pharmacy and take on the day of their procedure. A pharmacist may therefore be involved in the patient’s journey and ensure that they are given the correct and safe dose. Dental practitioners must thoroughly understand the proper dosing regimens, interactions, indications, and contraindications of the drugs prescribed.[24] Sedation-trained nurses not only support the dentist by assisting with the required equipment, but they can also monitor the patient throughout the treatment and raise concerns where necessary. Following treatment, nurses can also recover the patient in a separate area, allowing the clinic to be utilized more efficiently as the dental practitioner can proceed to the next patient. All team members must be sedation trained, correctly indemnified, and competent to carry out treatment under sedation. A logbook detailing each treatment should be recorded for patient safety reasons and as a resource for audits to improve current practice.[25]