Conscious Sedation

If a child is particularly nervous or needs to undergo a more difficult procedure, then at Atkinson Brignall, we are able to provide sedation techniques to help them cope. We do not provide general anaesthesia, with the techniques we offer, your child will remain awake but much more relaxed during the procedure. The 2009 NICE Guidelines define these techniques as “minimal sedation”.

Children can benefit from conscious sedation if they experience one or more of the following:

• Dental fear or anxiety of dental care
• Complex dental problems
• Too young to understand treatment
• Fear of injections
• Previous traumatic experience

The types of paediatric sedation available at Atkinson Brignall are :

• Oral conscious sedation
• Inhalation sedation
• Intravenous sedation

Oral Conscious Sedation

Young children approximately 2 -10 years old

Oral Conscious Sedation is a management technique that uses medications to assist the child to cope with fear and anxiety and co-operate with dental treatment. Medications and dosages will be carefully selected according to the age and weight of the individual child and will not cause loss of consciousness in your child.

Your dentist will provide your child with an oral medication (a benzodiazepine) in the form of a liquid, that is easy to administer and safe for the patient. When the medication takes effect (after about 15 minutes), your child will be able to speak and respond to external requests, however, they may not be coherent and their muscles will be very relaxed. During the appointment we usually allow the parent into the treatment area. This is to help parents understand the treatment that is being provided, though occasionally we ask parents to leave the surgery and wait in the recovery area.

Recovery takes half an hour or so. The accompanying parent should not bring other children as the post-sedated child needs to be closely supervised on the way home. Children who have been sedated are usually requested to remain at home for the rest of the day with adult supervision. It is not uncommon for the child to become disorientated or emotional even several hours after the appointment.

 Inhalation Sedation

Children approximately 2 yrs and onwards

One common treatment for children is Inhalation Sedation or Nitrous Oxide (commonly referred to as “happy air”, “happy gas” or “laughing gas”). Nitrous Oxide is a safe, effective technique and reduces a child’s fear of the dental visit. It is the same agent used in the gas and air of childbirth. The technique used was developed by Professor Roberts in the late 1970s. It is used widely in the UK, Europe and many countries across the world. It comprises a carefully controlled mixture of oxygen and nitrous oxide, the concentrations of which are adjusted to suit each child’s needs. When inhaled, it is absorbed by the body and has a profound calming effect. Normal breathing eliminates the nitrous oxide/oxygen mix from the body.

Nitrous oxide is delivered through a sterilised nose piece placed over the nose. After your child is made comfortable in the chair, they will smell a sweet, pleasant aroma and experience a sense of well-being and relaxation after approximately 5 minutes. If your child is worried by the sights, sounds or sensation of dental treatment, they may respond more positively with the use of nitrous oxide. During the administration of nitrous oxide, your child remains fully conscious and keeps all natural protective reflexes. After the treatment is completed, pure oxygen will be administered to ensure that all nitrous oxide is cleared from your child’s system. After a few minutes, we will sit your child up and ensure they can walk and is not experiencing any dizziness. You may notice that your child is a little groggy afterwards (similar to waking up from a night’s sleep). Your child will be fine to return home with a parent approximately 10 minutes after the appointment , and to resume normal activities within 30-60 minutes. We do, however, normally recommend that the child stays quietly at home for the rest of the day.

This technique has the advantage of rapid onset, effective sedation and analgesia, and rapid recovery.

Intravenous Sedation

Children 8 years old and onwards

This is intravenous access via a vein on the back of the hand or in the front of the elbow. As with oral sedation, the drug is a benzodiazepine- Midazolam. As a consequence of intravenous access the onset of sedation is swift. The total amount of drug delivered is carefully matched to the child’s needs to that the child is effectively sedated whllst conscious. This is not a general anaesthetic, so all the child’s reflexes are still working normally, making this a very safe procedure. During the procedure, for extra safety, all patients are monitored with a pulse oximeter, which clips over one of the fingers and shows us the oxygen levels in the blood at any one time.

Occasionally “happy air” or “happy gas” is administered to a very anxious patient to relax them sufficiently to enable the needle to be inserted into a vein thus allowing delivery of the Midazolam directly into the patient’s blood stream.

Recovery is not as fast as inhalation sedation. Children are usually ready to return home, accompanied by a parent, within an hour. It is recommended that the child stays quietly at home for the rest of the day. Written post-operative instructions will be provided.