Paediatric Sedation

Question 1

key aims of conscious sedation

Answer 1

1. remains conscious
2. retains protective reflexes
3. understands & responds to verbal commands

Question 2

anxiety assessment tools in children

Answer 2

adapted faces version of modified child dental anxiety scale (MCDASf)
scores form 9-45
no dental anxiety = 9
extreme anxiety / phobia = >31 or 5/5

Question 3

methods of pain & anxiety management (4)

Answer 3

1. NPBM (non pharmacological behaviour management)
2. LA
3. sedation
4. GA

Question 4

indications for IS

Answer 4

age
anxiety level (must be amenable to hypnotic suggestion)
management of gag reflex
must have nasal breathing i.e. emotionally & physically mature enough
medical considerations
previous dental history
dental needs

Question 5

during IS of children

Answer 5

keep talking to pt - agree pt to reply via nodding or thumbs up & continue behaviour management e.g. relaxation
ensure child avoids mouth breathing
monitoring - maximum when child reports tingling or starts giggling / over excited, stop if ears ringing or sore head
post op instruction

Question 6

TCI propofol

Answer 6

target controlled infusion (TCI) sedation
administered by anaesthetist
useful for very long and very short procedures
mean rapid onset & recovery

Question 7

3 key requirements in IS

Answer 7

1. pre op info
2. post op info
3. informed consent