New guidelines on dental sedation for kids
A new guideline published this week will ensure that anxious young NHS patients do not receive ineffective or unsafe sedation drugs ahead of any therapeutic or diagnostic procedure.
The National Institute for Health and Clinical Excellence (NICE) has developed this first-ever national guideline to improve NHS care and safety standards for sedating infants, children and teenagers.
Dr Fergus Macbeth, director of the Centre for Clinical Practice at NICE, said: ‘We know that large numbers of children undergo single or repeated procedures which may require sedation. These can include diagnostic tests, like a biopsy or MRI scan, or therapeutic procedures such as correcting a dislocated joint or dental treatment.
‘While the NHS uses numerous sedation techniques there is little guidance on which are most effective and what resources, including staff training, are needed to administer them safely. This guideline gives clear recommendations and promotes best practice on the use of sedation techniques to standardise the level of care children, young people and their families can expect from the NHS.’
Many children avoid treatment because of their phobia of the dentist’s chair, and conscious sedation – administered intravenously, orally or via inhalation – is considered an effective method of managing both pain and anxiety.
It allows the patient to maintain control over their breathing and swallowing during treatment and is best suited to:
· Patients who fear needles
· Patients requiring multiple dental procedures
· Patients who have a strong gag reflex
· Patients suffering from other physical disabilities.
However, standards of practice in delivering sedation vary greatly across the country.
The guideline incorporates a series of recommendations for healthcare professionals including nurses, anaesthetists, doctors and dentists.
Key recommendations include:
• Ensuring that trained healthcare professionals carry out pre-sedation assessments and document the results in the patient’s healthcare record
• Offering the child or young person (and their parents or carers) verbal and written information about the proposed sedation technique, the alternatives to sedation and associated risks and benefits
• For moderate and deep sedation, continuously monitor the child or young person, ensuring that the data is clearly documented in the patient’s healthcare record
Healthcare professionals delivering sedation should have documented up-to-date evidence of competency and should ensure they update their knowledge and skills through programmes designed for continuing professional development
Dr Paul Averley, a dentist from Teesside and guideline developer, said: ‘Sadly in the UK, many children continue to need invasive dental treatment. For these children, this dental treatment often brings anxiety. It is the responsibility of the dentist to control this anxiety.’
He adds: ‘Sedation can be a crucial tool to allow dental treatment to be carried out safely, effectively and cost effectively. If sedation is delivered correctly within dental practice, anxious children will be less likely to be referred to hospital where their treatment would be carried out under a general anaesthetic.
‘This valuable guideline will complement existing dentistry guidance on sedation and will provide a platform for dentists to build on and raise standards of care even further.’
• The NICE guideline on sedation in children and young people, including a version for patients and carers and corresponding implementation tools, are available from the NICE website at www.nice.org.uk/CG112 (from Wednesday 15 December 2010).
• The act of sedation is a drug-induced depression of consciousness. Sedation can help reduce fear and anxiety, provide pain control and minimise movement in the patient when undergoing a procedure.
There are varying levels of sedation and the following definitions are used in the guideline:
Minimal sedation: Where patients are awake and calm and respond normally to verbal commands
Moderate sedation: Where patients are sleepy but respond purposefully to verbal commands or light tactile stimulation
Conscious sedation: Similar to moderate sedation, except that verbal contact is always maintained with the patient. This is commonly used in dentistry
Deep sedation: Patients are asleep and cannot be easily roused but do respond purposefully to repeated or painful stimulation. Patients may need assistance to maintain a patent airway