SAAD digest最新文献

{"title":"Hazards.","authors":"J. Bourne","doi":"10.1002/9783527809080.cataz07772","DOIUrl":"https://doi.org/10.1002/9783527809080.cataz07772","url":null,"abstract":"","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"8 1","pages":"186-7"},"PeriodicalIF":0.0,"publicationDate":"2020-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83718546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bispectral Index Guided Target Controlled Midazolam Sedation: a new advanced technique for dental procedures.","authors":"T. H. van den Berg, B. Preckel","doi":"10.1111/jcpe.387_12915","DOIUrl":"https://doi.org/10.1111/jcpe.387_12915","url":null,"abstract":"Objectives\u0000To assess the efficacy and safety of Bispectral Index\u0000(BIS) guided Target Controlled Infusion (TCI) of midazolam for\u0000anxiolysis or minimal sedation during extensive periodontal or\u0000implant surgery in a single operator/sedationist model.\u0000\u0000\u0000Methods\u0000Retrospective analysis of thirty adult ASA 1 or ASA 2\u0000patients undergoing periodontal surgery or dental implant surgery\u0000under local anaesthesia were included.\u0000The calculated effect site concentration (Ce) of midazolam applied\u0000by TCI, BIS, heart rate (HR), and peripheral oxygen saturation (SpO2)\u0000were monitored continuously. Non-invasive blood pressure (NIBP)\u0000and mean arterial pressure (MAP) were measured every 10\u0000minutes. All peri-operative parameters were recorded every\u000010 minutes. All patients were interviewed 1 week after the\u0000procedure to explore their experience of sedation and the\u0000periodontal or implant surgery procedure.\u0000\u0000\u0000Results\u0000Extensive periodontal or implant surgery treatment in all\u000030 patients was completed in a mean time of 120 min (range\u000050-180 min). The calculated mean effect site concentration for\u0000midazolam was 50 ng/ml (range 24-80). The mean BIS was 85\u0000(74-100) during induction and was maintained between 80 and 90\u0000during the oral surgical procedure by adjusting TCI Ce. There were\u0000no clinically significant cardiopulmonary changes during\u0000midazolam infusion with regard to SpO2, NIBP, MAP and heart rate.\u0000Patients experienced profound anterograde amnesia and were\u0000very satisfied with the sedation and the surgical procedure.\u0000\u0000\u0000Conclusions\u0000BIS guided TCI sedation with midazolam facilitates\u0000predictable minimal sedation enabling long periodontal or implant\u0000surgery procedures by a single operator/sedationist within safe\u0000physiological limits.","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"22 1","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78718846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthesia and Sedation for the Autistic Patient.","authors":"Sarah Sacoor","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Autism is a disability that affects how a person communicates and\u0000relates to the world around them. Patients on the autistic\u0000spectrum may be referred to a Special Care Dentistry service to be\u0000managed under sedation or general anaesthetic, as their visit to\u0000the dentist can be stressful and disruptive to their routine. As it is a\u0000spectrum disorder, each patient needs to be assessed individually\u0000in order to determine whether sedation or general anaesthetic\u0000would be appropriate for them. Some autistic patients may have\u0000good verbal communication and mild learning difficulties, and\u0000may be able to tolerate treatment under local anaesthetic with\u0000behavioural management alone. On the other end of the\u0000spectrum, patients with severe autism and learning difficulties\u0000may not permit the dentist to even examine them and will require\u0000a general anaesthetic. There will also be patients on the autistic\u0000spectrum who are suitable for conscious sedation depending on\u0000their level of learning difficulty and cooperation. Oral and\u0000transmucosal sedation can also be useful for providing presedation\u0000to a patient to facilitate venous access. In order to\u0000minimise distress to the patient, it is important that adequate\u0000sedation, anaesthesia and analgesia are achieved both perioperatively\u0000and post-operatively.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"40-3"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35975197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bispectral Index Guided Target Controlled Midazolam Sedation: a new advanced technique for dental procedures.","authors":"T H van den Berg,&nbsp;B Preckel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the efficacy and safety of Bispectral Index\u0000(BIS) guided Target Controlled Infusion (TCI) of midazolam for\u0000anxiolysis or minimal sedation during extensive periodontal or\u0000implant surgery in a single operator/sedationist model.</p><p><strong>Methods: </strong>Retrospective analysis of thirty adult ASA 1 or ASA 2\u0000patients undergoing periodontal surgery or dental implant surgery\u0000under local anaesthesia were included.\u0000The calculated effect site concentration (Ce) of midazolam applied\u0000by TCI, BIS, heart rate (HR), and peripheral oxygen saturation (SpO2)\u0000were monitored continuously. Non-invasive blood pressure (NIBP)\u0000and mean arterial pressure (MAP) were measured every 10\u0000minutes. All peri-operative parameters were recorded every\u000010 minutes. All patients were interviewed 1 week after the\u0000procedure to explore their experience of sedation and the\u0000periodontal or implant surgery procedure.</p><p><strong>Results: </strong>Extensive periodontal or implant surgery treatment in all\u000030 patients was completed in a mean time of 120 min (range\u000050-180 min). The calculated mean effect site concentration for\u0000midazolam was 50 ng/ml (range 24-80). The mean BIS was 85\u0000(74-100) during induction and was maintained between 80 and 90\u0000during the oral surgical procedure by adjusting TCI Ce. There were\u0000no clinically significant cardiopulmonary changes during\u0000midazolam infusion with regard to SpO2, NIBP, MAP and heart rate.\u0000Patients experienced profound anterograde amnesia and were\u0000very satisfied with the sedation and the surgical procedure.</p><p><strong>Conclusions: </strong>BIS guided TCI sedation with midazolam facilitates\u0000predictable minimal sedation enabling long periodontal or implant\u0000surgery procedures by a single operator/sedationist within safe\u0000physiological limits.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35976058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of General Anaesthesia in Special Care & Paediatric Dentistry; Inclusion Criteria and Clinical Indications.","authors":"Arkadiusz Dziedzic","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dental practitioners dealing with children and individuals with\u0000special needs can be supported by the provision of general\u0000anaesthesia for the most challenging patients in situations where\u0000other options are insufficient. The availability of general\u0000anaesthesia will further the aim of extending access to the widest\u0000range of dental care to the greatest number of patients regardless\u0000of disability, age or phobia. The objective is to ensure patients have\u0000a pain-free and healthy mouth, and any necessary treatment in the\u0000most appropriate setting related to their specific needs. A strictly\u0000individual and holistic approach is required when evaluating the\u0000risk versus benefit of proceeding with general anaesthesia for\u0000delivery of dental treatment particularly for children and special\u0000needs individuals. It is vitally important to consider and address all\u0000relevant factors specific to this particular group of patients\u0000including assessment of capacity, validity of consent, and any\u0000specific medical, social and behavioural issues. The other sedation\u0000modalities must be always taken into consideration.\u0000This article emphasises the crucial decision-making role of dentists\u0000in the referral process for dental treatment under general\u0000anaesthesia and the need for multidisciplinary co-operation\u0000between dental practitioners, community and hospital services.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"48-54"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35977714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What’s new in... Capnography Monitoring for Dental Conscious Sedation: A Clinical Review.","authors":"Paul J Brady,&nbsp;Martina Hayes,&nbsp;Christine E McCreary,&nbsp;Ken D O'Halloran,&nbsp;Joseph A Giovannitti","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Capnography monitoring during conscious sedation is not\u0000currently required for dentistry in Britain and Ireland. Other\u0000countries have introduced guidelines and standards requiring\u0000capnography monitoring for procedural sedation. This review\u0000highlights the variability of procedural sedation including the\u0000setting, the position on the sedation continuum, and the routine\u0000use of supplemental oxygen. Specific research is required for\u0000conscious sedation in a dental setting to support standards and\u0000guidelines with regard to capnography monitoring.\u0000The Academy of Medical Royal Colleges and their Faculties\u0000emphasise that each specialty must produce its own guidance for\u0000the use of sedative techniques.1 Clinical practice guidelines for the\u0000monitoring and safe practice of sedation vary by specialty and\u0000institution. Standards are generally set from the best available\u0000evidence based research. There is a growing body of literature that\u0000recognises the potential additional value of capnography (ETCO2)\u0000monitoring during procedural sedation in different settings and for\u0000different sedation techniques.2-5 In these studies, capnography\u0000reduced the incidence of hypoxaemia during procedural sedation.\u0000A meta-analysis published by Waugh et al. (2010) concluded that\u0000end-tidal carbon dioxide monitoring is an important addition in\u0000detecting respiratory depression during procedural sedation.6 A\u0000more recent systematic review by Conway et al. (2016) concluded\u0000that patients monitored with capnography in addition to standard\u0000monitoring had a reduced risk of hypoxaemia compared to those\u0000with only standard monitoring.7 However, it has to be noted that\u0000both the Waugh and Conway reviews contained substantial\u0000statistical heterogenicity which is likely to affect the quality of the\u0000evidence.\u0000As research evidence for capnography monitoring from the\u0000medical settings studied became available, new standards for\u0000capnography monitoring were introduced in several countries\u0000(Table 1).</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"3-6"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35976057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the Mental Capacity Act (2005) and Consenting for Treatment under Concious Sedation.","authors":"Tashfeen Kholasi,&nbsp;Emily Sherwin,&nbsp;Chris Dickinson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Mental Capacity Act 2005 (MCA) is one piece of legislation\u0000with which all clinicians should be familiar. As treating clinicians, a\u0000capacity assessment is carried out each time a patient is seen, in\u0000order to obtain informed consent. When clinicians question the\u0000capacity of their patients, they should ensure steps are taken to\u0000provide relevant adjuncts to aid understanding, from visual aids to\u0000alternative time and environment. If a patient is deemed to lack\u0000capacity, it should be determined if this is temporary, fluctuating or\u0000permanent, as well as the severity. For those who lack capacity a\u0000best interest assessment should be undertaken with all relevant\u0000parties involved, with the overall decision being made in the\u0000patient’s best interest and in the least restrictive manner.\u0000Considerations of sedation technique, clinical holding, or any other\u0000procedures should be included in the consent form, with periodic\u0000review of the best interest decision as a patient’s circumstances\u0000may change over time.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"24-8"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35975493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behaviour Management of Children Presenting in the Emergency Department with OMFS Problems.","authors":"Sami Stagnell","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>This paper is a summary of three case reports of patients treated\u0000by Oral and Maxillofacial (OMFS) Dental Foundation Trainees\u0000(DF2s) at a busy London paediatric Accident and Emergency (A&E)\u0000department.</p><p><strong>Discussion: </strong>Behavioural management for paediatric patients is challenging.\u0000The authors discuss various non-pharmacological behavioural\u0000management methods as stand-alone techniques or as an adjunct\u0000to drugs (sedation or anaesthesia). They highlight three cases\u0000where a dedicated Play-Specialist is employed to assist treatment\u0000undertaken in an acute hospital setting. Here we discuss options\u0000available to clinicians for behaviour management as well as three\u0000case scenarios detailing the use of Play-Specialists alongside\u0000conventional pharmacological and non-pharmacological\u0000methods.</p><p><strong>Conclusion: </strong>Through implementing appropriate behavioural management\u0000methods (with or without drugs), optimal patient care can be\u0000achieved. The benefit of having a specialist solely trained in\u0000engaging with children, with respect to their behavioural\u0000tendencies, is demonstrated, highlighting their value in an acute\u0000setting.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"55-61"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35975202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of the use of Flumazenil for the Reversal of Midazolam Conscious Sedation in Dentistry.","authors":"Laurence Folland,&nbsp;Emma Brown,&nbsp;Carole Boyle","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The practice of midazolam conscious sedation is well established\u0000in dentistry. The drug flumazenil is a specific benzodiazepine\u0000antagonist and is an essential requirement in settings where\u0000midazolam is used.\u0000A literature review has been carried out, examining the available\u0000information regarding flumazenil’s safety, administration, potential\u0000complications and the regulatory documentation which governs\u0000its use.\u0000Flumazenil is a safe drug to use for the reversal of midazolam\u0000induced conscious sedation although the evidence surrounding its\u0000use is limited.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"13-7"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35976059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Decisional Needs of Young Patients Faced with the Decision to Undergo Dental Treatment with Sedation or GA.","authors":"Joe Hulin,&nbsp;Sarah Baker,&nbsp;Zoe Marshman,&nbsp;Sondos Albadri,&nbsp;Helen Rodd","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To explore the decisional needs of young patients faced with\u0000the choice of dental treatment with either sedation or general\u0000anaesthetic (GA).</p><p><strong>Design: </strong>Twelve qualitative interviews were conducted with\u0000patients, aged 10-16 yr (n=12), who had prior experience of dental\u0000treatment with sedation or GA, together with their parents/\u0000guardians (n=13).</p><p><strong>Results: </strong>A number of themes were identified as being important in\u0000the decision-making process including: the method of\u0000administration; waiting and treatment times; perceived side effects\u0000and risks; treatment type; control and communication, and the long\u0000term impact of sedation or GA.</p><p><strong>Conclusion: </strong>The decision to undergo dental treatment with\u0000sedation or GA is a complex healthcare decision and warrants\u0000additional decisional support for both patients and their parents/\u0000guardians.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"33 ","pages":"18-23"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35975494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}