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The ability to manage an airway is an essential skill for the safe provision of intravenous conscious sedation. A systematic airway assessment will allow identification of risk factors pre-operatively, flagging potential airway problems and aiding case selection. If difficulties arise, the practitioner will be able to act efficiently having anticipated the risk factors. Importantly, cases unsuitable for primary care can be readily identified and referred appropriately. In the interest of patient safety, this article aims to present methods of airway assessment that can be incorporated into the pre-sedation assessment.
CPD/Clinical Relevance: This article discusses airway assessment methods relevant to intravenous conscious sedation to promote patient safety.
Article
The use of midazolam for intravenous sedation in primary dental care has been proven safe and effective. The safety of conscious sedation is dependent on a thorough pre-operative assessment, careful administration and monitoring throughout. The Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) guidelines1 state that sedation dentists must be able to ‘carry out airway assessment and anticipate potential difficulties during sedation or if ventilation is required’. The Scottish Dental Clinical Effectiveness Programme (SDCEP) guidelines2 echo this requirement and state that potential airway difficulties should be assessed and documented at the pre-sedation assessment.
The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach towards medical emergencies is well known and highlights the primary importance of the patient's airway. Nevertheless, guidance for airway assessment within dental sedation is limited.
Conscious sedation is defined as: ‘a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.’1,2 Consequently, a patient should be able to maintain their airway reflexes throughout dental conscious sedation. Midazolam can be titrated until the desired clinical effect is achieved and it has a wide margin of safety, making it the drug of choice for dentist-led intravenous conscious sedation.
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