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SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability
Author(s): M. Keddie, H. Vincer, P. Shah, M. Doshi 

Abstract: 

Introduction
When providing intravenous sedation for patients with severe disabilities who have limited verbal communication it can sometimes be challenging to identify when sedation endpoint is reached. Bispectral index monitoring can provide an objective measure of the depth of sedation.

Aim
This study aims to assess the feasibility of bispectral index monitoring in adults with cognitive impairment with limited to no verbal communication undergoing dental treatment with midazolam conscious sedation.

Method
Bispectral monitoring was applied to patients with a neurodisability or a learning disability who were undergoing dental treatment under intravenous sedation, across three sites. A researcher observed whether the sensor could be applied and how the bispectral index changed during sedation and recovery.

Results
31 patients were recruited. In most cases it was possible to apply sensors before, or soon after, midazolam was titrated. A pattern of a decrease in bispectral values towards the end point, and an increase towards recovery was noted. Fluctuations in bispectral readings were seen during treatment, likely due to facial muscle movements.

Conclusion
Bispectral index monitoring could be a valuable adjunct when training dentists in sedation in special care dentistry and may be of particular use in patients with neurodisability.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

 Article title
 Page start
Page end
 Editorial
 2
 2
Peer reviewed papers
Remimazolam compared to midazolam for dental sedation: an umbrella review
 3
 8
A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry
 9
 14
Improving safety and efficiency in special care dentistry through quality improvement of patient information in the Belfast Trust  
 15
 18
Patient experiences and outcomes following intravenous sedation in an oral surgery setting 
 19
 22
An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability 
 23
 27
Are we providing an effective sedation service? An evaluation of a new conscious sedation service in primary special dental care 
 28
 32
An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison 
 33
 36
Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
 37
 41
The effectiveness of dental nurse led Cognitive Behavioural Therapy (CBT) on the dentally anxious patient: a service evaluation
 42
 46
Case reports
Dental treatment for a 15-year-old patient with Nicolaides- Baraitser Syndrome, under intravenous sedation with midazolam: a case report
 47
49 
The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient 
 50
53
Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars 
 54
 56
Opinion
 57
 59
Journal Scan
 60
 68
Essay prizes
Dexmedetomidine: pharmacology and use as a sedative agent 
 69
 76
Do children from more deprived backgrounds have a higher chance of becoming dentally anxious?
 77
 80
Symposium 2023
 81
 89
Profile
 90
90 
Forum  92 97