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Cover
Title Page
About the Companion Website
1 Spectrum of Anxiety Management
1. Introduction
2. Fear and Anxiety as a Normal Phenomenon
3. Aetiology of Dental Anxiety
4. Measuring Dental Anxiety
5. Behaviour
6. Behaviour Management
7. Conscious Sedation
8. General Anaesthesia
9. References
10. Further Reading
2 Applied Anatomy and Physiology
1. Introduction
2. Cardiovascular System
3. Vascular Anatomy of Upper Limb Relevant to Sedation
4. Route of Drug Transfer to the Brain
5. Respiratory System
6. Intravenous Drugs and Excretion
7. Further Reading
3 Patient Assessment
1. Introduction
2. Assessment Process
3. Preparation of Patients for Sedation
4. Reference
5. Further Reading
4 Pharmacology of Sedation Agents
1. Introduction
2. Inhalation Sedation Agents
3. Intravenous Sedation Agents
4. Basic Pharmacology of Intravenous Sedatives
5. Further Reading
5 Premedication, Oral and Intranasal Sedation
1. Premedication
2. Oral Sedation
3. Intranasal Sedation
4. Summary
5. Further Reading
6 Principles and Practice of Inhalation Sedation
1. Introduction
2. Inhalation Sedation in Dentistry
3. Further Reading
7 Principles and Practice of Intravenous Sedation
1. Introduction
2. Intravenous Sedation
3. Further Reading
8 Complications and Emergencies
1. Introduction
2. Emergency Equipment
3. Airway Management
4. Drug Administration
5. Sedation‐Related Emergencies
6. Medical Emergencies
7. Local Complications with Intravenous Sedation
8. Further Reading
9 Sedation and Special Care Dentistry
1. Introduction
2. The Use of Conscious Sedation
3. Summary
4. References
5. Further Reading
10 Medico‐Legal and Ethical Considerations
1. Introduction
2. The Legal System in the United Kingdom
3. Rights and Responsibilities of a Patient
4. Duties and Responsibilities of the Dentist
5. Criminal and Civil Charges
6. Consent
7. Risk Assessment
8. Dealing with Sedation‐Related Incidents
9. Reference
10. Further Reading
Index
End User License Agreement

List of Tables

Chapter 02
1. Table 2.1 Average heart rates.
2. Table 2.2 Definition and classification of blood pressure levels (mmHg).
3. Table 2.3 Lung volumes.
Chapter 03
1. Table 3.1 ASA classification system.
2. Table 3.2 Interactions of benzodiazepines with other drug groups.
3. Table 3.3 Blood pressure values and associated ASA class.
4. Table 3.4 BMI classification.
Chapter 04
1. Table 4.1 Health risks of chronic exposure to nitrous oxide.
2. Table 4.2 Properties of main benzodiazepine drugs used for sedation.
Chapter 08
1. Table 8.1 Emergency equipment essential for the provision of conscious sedation.
2. Table 8.2 Emergency drugs, doses and application.

List of Illustrations

Chapter 01
1. Figure 1.1 A model of dental fear in children proposed by Chapman (1999).
2. Figure 1.2 Visual analogue scale – A straight line measuring 10 cm, labelled Very Anxious at one end to Not at all Anxious at the other end. The patient is asked to place a X on the line to represent the extent of their anxiety.
3. Figure 1.3 Smiley faces anxiety scale – The child is asked to circle the face that best represents how they feel.
4. Figure 1.4 Factors influencing behaviour.
5. Figure 1.5 Ceiling‐mounted television.
6. Figure 1.6 By explaining the procedure to the patient and showing them the equipment the patient may feel more confident to proceed with treatment.
Chapter 02
1. Figure 2.1 Transverse section of an artery and vein. A, Artery, lined with nucleated endothelium (e). Underneath the endothelium is the elastic lamina muscle layer (m). The muscle layer is surrounded by connective tissue fibres, the adventitia (a). V, Vein, has thin endothelial lining (e), under which is a very thin muscle layer (m). The adventia (a) is similar to the artery.
2. Figure 2.2 Cross‐section of the heart illustrating the flow of blood through the chambers and large vessels.
3. Figure 2.3 Conduction system of the heart: 1 – Sinoatrial node; 2 – Atrioventricular node; 3 – Bundle of His; 4 – Bundle branches; 5 – Purkinje fibres.
4. Figure 2.4 Circulation of blood through the vascular system.
5. Figure 2.5 Veins of the dorsum of the hand.
6. Figure 2.6 Antecubital fossa illustrating the three important structures to be aware of: brachial artery, median nerve and bicipital aponeurosis.
7. Figure 2.7 Upper airway.
8. Figure 2.8 Lower airway.
9. Figure 2.9 The control of respiration is influenced at several points. At point A, the respiratory centre is affected by all modern sedatives. At points B and C, the phrenic nerve and neuromuscular junction respectively, the influences are less profound.
10. Figure 2.10 Graphical representation of lung volumes: TV – Tidal volume; ERV – Expiratory reserve volume; IRV – Inspiratory reserve volume; FRC – Functional reserve capacity; VC – Vital capacity; RV – Residual volume; TLC – Total lung capacity.
11. Figure 2.11 Oxygen/haemoglobin dissociation curve. The curve can be displaced to the left or the right by systemic influences.
12. Figure 2.12 Principles involved in oxygen availability.
13. Figure 2.13 The distribution of an intravenously injected drug.
14. Figure 2.14 Recovery from intravenous sedation occurs initially by redistribution of the drug into adipose tissue followed by elimination of the drug by the liver and kidney.
Chapter 03
1. Figure 3.1 Mallampati score.
2. Figure 3.2 Written instruction sheet for patients scheduled for treatment under sedation.
3. Figure 3.3 Sedation assessment record.
Chapter 04
1. Figure 4.1 Movement of nitrous oxide gas down the partial pressure gradient during induction and recovery from inhalational sedation.
2. Figure 4.2 The pressure in the nitrous oxide cylinder remains constant and tends to fall rapidly immediately before the cylinder becomes empty.
3. Figure 4.3 Biochemical effect of chronic exposure to nitrous oxide.
4. Figure 4.4 Mechanism of action of gamma‐aminobutyric acid (GABA).
5. Figure 4.5 Chemical structure of diazepam, showing a benzene ring structure attached to the diazepine part of the molecule.
6. Figure 4.6 Chemical structure of midazolam, showing a benzene ring structure attached to the diazepine part of the molecule.
7. Figure 4.7 Chemical structure of flumazenil, the benzodiazepine antagonist. The molecule has no benzene ring attached to the diazepine group.
8. Figure 4.8 Infusion pump used for the delivery of propofol sedation.
9. Figure 4.9 Button used by patient to administer propofol.
Chapter 05
1. Figure 5.1 Nasal syringes for administration of intranasal midazolam.
Chapter 06
1. Figure 6.1 Guedel’s stages of anaesthesia. Stage 1 is subdivided into three planes of analgesia.
2. Figure 6.2 Free‐standing inhalation sedation machine.
3. Figure 6.3 Piped inhalation sedation system.
4. Figure 6.4 Quantiflex MDM®, flow control head, showing nitrous oxide and oxygen flow meters, mixture control dial, flow control knob and oxygen flush button.
5. Figure 6.5 The reservoir bag is situated just below the flow control head.
6. Figure 6.6 Inhalation sedation nose mask, showing the inner and outer units.
7. Figure 6.7 Pre‐procedural checklist for inhalation sedation.
8. Figure 6.8 The nose mask is shown to the patient and the procedure explained.
9. Figure 6.9 The nose mask is comfortably positioned on the patient’s nose. It is important to check for a good seal around the mask to prevent leakage.
10. Figure 6.10 Spoken and written post‐operative instructions are given to the patient and their escort.
11. Figure 6.11 Treatment record sheet for inhalation sedation.
Chapter 07
1. Figure 7.1 Equipment required for the administration of intravenous sedation agents.
2. Figure 7.2 Pre‐operative checklist for intravenous sedation including information about the emergency equipment, intravenous sedation equipment and patient details.
3. Figure 7.3 Dorsum of the hand, showing the network of superficial veins.
4. Figure 7.4 Insertion of the cannula. The skin is held taught and the cannula angled at 10–15 degrees to enter the vein.
5. Figure 7.5 A small flashback of blood confirms that the cannula is in the lumen of the vein.
6. Figure 7.6 As the needle is withdrawn a further flashback of blood is seen within the cannula tube.
7. Figure 7.7 The cannula is fixed in place. Special fixing plasters or micropore tape may be used.
8. Figure 7.8 The position of the cannula is checked by injecting 2 ml of 0.9% saline.
9. Figure 7.9 Titration of the sedation agent, midazolam at a rate of 1 mg/min.
10. Figure 7.10 Inability to touch the tip of the nose with the forefinger indicates loss of motor co‐ordination and is known as Eve’s sign.
11. Figure 7.11 The pulse oximeter measures the patient’s arterial oxygen saturation and heart rate using a finger or ear lobe probe.
12. Figure 7.12 Nasal oxygen is administered via a nasal cannula.
13. Figure 7.13 The patient’s blood pressure is most easily monitored before, during and after treatment using an electromechanical blood pressure machine.
14. Figure 7.14 Following treatment the patient is escorted to the recovery area where monitoring continues until discharge.
15. Figure 7.15 Written post‐operative instructions are given to the patient and their escort prior to discharge.
16. Figure 7.16 The cannula is removed just before the patient is discharged.
17. Figure 7.17 The patient should be monitored throughout their treatment and all information entered on the sedation treatment form.
Chapter 08
1. Figure 8.1 Guedel oral airways.
2. Figure 8.2 Nasopharyngeal airway.
3. Figure 8.3 Ambu‐bag with reservoir bag.
4. Figure 8.4 Pocket mask used for giving rescue breaths during cardiopulmonary resuscitation.
5. Figure 8.5 Example of emergency drugs.
6. Figure 8.6 Automated external defibrillator.
7. Figure 8.7 Algorithm for adult basic life support.
8. Figure 8.8 The ‘chain of survival’.
Chapter 09
1. Figure 9.1 Patients requiring treatment on a day‐stay basis are often managed in a theatre setting with full anaesthetic support.

Pages

This edition first published 2018
© 2018 John Wiley & Sons Ltd

Edition History
© 2009 N. M. Girdler, C. M. Hill, K. E. Wilson

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Library of Congress Cataloging‐in‐Publication Data

Names: Girdler, N. M., author. | Hill, C. M., author. | Wilson, K. E. author.
Title: Conscious sedation for dentistry / N. M. Girdler, C. M. Hill, K. E. Wilson.
Other titles: Clinical sedation in dentistry
Description: Second edition. | Hoboken, NJ, USA ; Chichester, West Sussex, UK : John Wiley & Sons Ltd., 2017. |
Preceded by: Clinical sedation in dentistry / N.M. Girdler, C. Michael Hill, Katherine Wilson. Chichester,
West Sussex: Wiley‐Blackwell, 2009. | Includes bibliographical references and index.
Identifiers: LCCN 2017014485 | ISBN 9781119274476 (pbk.)
Subjects: | MESH: Conscious Sedation | Anesthesia, Dental
Classification: LCC RK510 | NLM WO 460 | DDC 617.9/676–dc23
LC record available at https://lccn.loc.gov/2017014485

Cover design: Wiley
Cover image: (Background) barbaliss/Shutterstock;
(Photos) Courtesy of N. M. Girdler, C. M. Hill, and K. E. Wilson