This study offers confirmation that IV sedation techniques utilized in the general practice setting are a modality of pain and anxiety control that is amenable to the short turnover times encountered in general practice. Even the use of strict discharge criteria did not seem to have an impact on the recovery time in this study. Patients recovered within a minimal amount of time and were street fit and capable of being discharged in a relatively brief time span. The recovery times obtained were consistent with the short turnover times encountered in private general practice. Neither procedure length and complexity nor patient age or weight seemed to have an impact on the recovery times encountered in this study. The use of appropriate discharge criteria allows for the discharge of the patient when he or she is physiologically ready. Previous studies used discharge criteria that were either vague or inappropriate. Unlike general surgery, where the effects of the procedures may have a major influence on recovery and discharge, dental procedures are much less invasive and in the general dental practice setting do not generally influence recovery speed and discharge time. Anecdotally, operating conditions were improved for the operating dentists, and many commented that the procedures took less time than they had anticipated. It would be interesting to compare these results with those obtained from a larger institutional center that administered ambulatory IV sedation for the full range of general dental practice as opposed to the more generally studied oral surgery model. Read the rest of this entry »

Patients included in the study ranged in age from 15 to 66 years, with an average of 37.8 ± 12.1 years. Weights ranged from 43 to 120 kg, with an average of 75.8 ± 15.4 kg (the Table). The majority were American Society of Anesthesiologists Category 1 and Category 2 patients (98%). Procedures undertaken included conservative dentistry, endodontic procedures, post and core preparations, crown preparations and impression, impressions for partied dentures, prophylaxis, simple extractions, surgical extractions, first stage implant placements, and regenerative membrane placement.

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All patients in this study were American Society of Anesthesiologists Category 1 and Category 2 patients undergoing general dental treatment. Written informed consent for the IV sedation was obtained from patients or their guardian before starting the procedure. Patients or their guardians were issued a written list of presedation instructions. All patients were examined before sedation, and baseline vital signs were recorded. Vital signs were monitored during sedation, treatment, and recovery. Vital signs monitoring consisted of continuous pulse oximetry and pulse rate monitoring (INVIVO Model 4500; Invivo Research Inc, Orlando, Ra) as well as noninvasive blood pressure monitoring (Omron M4; Omron Corporation, Tokyo, Japan). This is the standard of monitoring required for patient safety and is consistent with the Policy document on sedation for dental procedures as agreed between the Royal Australasian College of Dental Surgeons and the Australian and New Zealand College of Anaesthetists. Vital signs for each patient were recorded every 5 minutes during the procedures and during recovery. Patients were most often allowed to recover in the dental chair and were usually not moved until they were ready to be discharged. A standardized written medical questionnaire (Australian Dental Association, West Australia Branch) was also used as a screening tool to identify any medical risk before treatment.

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Intravenous (IV) sedation has been used in dentistry for many years. One of its many perceived advantages over general anesthesia is the shorter recovery times attributed to this modality of pain and anxiety control. Other advantages include less patient preparation, reduced monitoring equipment requirements, and less stringent training for the personnel involved. However, most available studies of recovery times compare different drug protocols and were undertaken in controlled circumstances, such as hospitals and university medical centers, and not in the primary care setting. The studies available are not clear on the discharge criteria utilized. For example, many such studies simply do not state the criteria that are applied, or they use discharge criteria that are inappropriate for sedation in the dental general practice setting such as modified Romberg and “P” tests. This retrospective study was designed to examine the data available from the IV sedation records for an 18-month period available with 1 general anesthesia-trained dental practitioner (first author) who provides ambulatory sedation services to a number of private general dental practices in the Perth, Western Australia metropolitan area. The aim of this study was to describe the recovery times when sedation was conducted in private dental practice and to consider this in relation to age, weight, procedure type, and procedure time. Read the rest of this entry »