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SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
Author(s): J. Li, J. Joseph, X. Yeo, H. Hossenally

Abstract: 

Introduction
Dentist-led conscious sedation improves access to dental care for patients with a learning disability (LD) and autism spectrum disorder (ASD). This service evaluation investigated cases of unsuccessful sedation to study the demographic and trend.

Aims

  • To evaluate the reasons for failure of intranasal, oral, and intravenous (IV) conscious sedation
  • To assess if there is a correlation between patient factors and sedation failure
  • To identify if there are ways to improve the success of conscious sedation for patients with LD and ASD.

Methodology
A retrospective review of clinical notes of unsuccessful sedation cases was conducted from January 2019 to July 2021 across two dental services in London. Unsuccessful sedation was defined as ‘planned treatment unable to be carried out in its entirety, not including treatment modifications’.

Results
A total of 452 patients with LD / ASD were included. Unsuccessful sedation was reported in 34 cases (7.5%). All patients lacked capacity and 62% were non-verbal. Reasons for failure included: failure to cannulate (44%); movement (38%); challenging behaviour (9%); inability to maintain satisfactory oxygen saturation (3%); and short sedation window (6%). The mean dose of IV midazolam administered was 8 mg (range 2 - 18 mg).

Conclusion
Multiple patient factors play a role in unsuccessful sedation. Improved and standardised documentation of sedation and operating conditions are needed to facilitate further evaluation.

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