CHANGING TRENDS IN DENTAL PROCEDURAL SEDATION

Although most dental procedures are amenable under local anesthesia, but many a time, depending on the extent of procedure, anxiety or phobia, patient needs some degrees of sedation. Procedural sedation outside the operating room increases the risk of adverse events. Most commonly, near miss or critical events occur due to operator error or lack off rescue systems. Unfamiliar location, inadequate monitoring, insufficient or untrained staff and non-availability of emergency resuscitation equipment or medication in emergency situations are some of the major factors for adverse outcome. Proper monitoring; provision of readily available access to resuscitation facility and continuous presence of anesthesiologist have contributed to the decrease in death and disability caused by anesthesia related adverse events. Pre-procedural evaluation is done to screen patients for suitability for procedural sedation and assess the risk factors. Patients with full stomach, difficult airway or significant medical illness requiring more than mild sedation, alternative to procedural sedation should be consider. Clinician performing procedural sedation should have through knowledge of action, dose, side-effects, and antidote of commonly used sedative analgesics. Newer and innovative techniques have been evolved recently including transmucosal, transnasal, inhalational anesthetic, patient controlled sedation, target controlled sedation. All patients after dental procedural sedation should be monitored in a designated recovery area and should not be discharged until they meet all the discharge criteria and while sending home, proper written discharge instruction should be provided to all.