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Ruth Freeman - One of the best experts on this subject based on the ideXlab platform.
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Relative Analgesia and general dental practitioners attitudes and intentions to provide conscious sedation for paediatric dental extractions
International Journal of Paediatric Dentistry, 2003Co-Authors: Ruth Freeman, P. CarsonAbstract:Summary. Aim. To examine the attitudes and intentions of general dental practitioners (GDPs) who work within the remit of the National Health Service (NHS) to provide Relative Analgesia (RA) for paediatric extractions. Methods. All 45 GDPs working within the boundaries of one Trust were asked to complete a questionnaire to assess demography, etc., intention and attitudes to provide RA for paediatric extractions. Results. Ninety-eight per cent of GDPs took part. All GDPs worked within the NHS. Twenty-nine per cent of GDPs stated that they had RA equipment available in their practices and 68% stated that they discussed RA as treatment alternative. Eighty-seven per cent referred their paediatric extraction cases for dental general anaesthesia. The behavioural intention was predicted by total attitude score and the availability of RA equipment in the practice (R2 = 0·97, F(37,5) = 260·11, P < 0·001). Total attitude was predicted by clinical competency, few financial worries or time concerns and the availability of RA equipment (R2 = 0·91, F(38,4) = 106·21, P < 0·001). Conclusions. This study suggests that GDPs’ concerns of clinical competence and costs have an inhibiting effect upon their intention to provide RA for paediatric extractions. These concerns must be addressed by planners and policy makers if there is to be a shift from hospital-based DGA to surgery-based RA services for paediatric extractions.
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Relative Analgesia and general dental practitioners: attitudes and intentions to provide conscious sedation for paediatric dental extractions.
International journal of paediatric dentistry, 2003Co-Authors: Ruth Freeman, P. CarsonAbstract:Summary. Aim. To examine the attitudes and intentions of general dental practitioners (GDPs) who work within the remit of the National Health Service (NHS) to provide Relative Analgesia (RA) for paediatric extractions. Methods. All 45 GDPs working within the boundaries of one Trust were asked to complete a questionnaire to assess demography, etc., intention and attitudes to provide RA for paediatric extractions. Results. Ninety-eight per cent of GDPs took part. All GDPs worked within the NHS. Twenty-nine per cent of GDPs stated that they had RA equipment available in their practices and 68% stated that they discussed RA as treatment alternative. Eighty-seven per cent referred their paediatric extraction cases for dental general anaesthesia. The behavioural intention was predicted by total attitude score and the availability of RA equipment in the practice (R2 = 0·97, F(37,5) = 260·11, P
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Dental caries, age and anxiety: factors influencing sedation choice for children attending for emergency dental care.
Community dentistry and oral epidemiology, 2001Co-Authors: Pauline Carson, Ruth FreemanAbstract:Abstract –Objectives: The aim of the study was to examine how physical (dental caries) and psychosocial (age, dental anxiety and dental health behaviour) factors, associated with child and parent, influenced dentists’ sedation choice when a child presents in pain. Methods: 600 parents whose children were aged between 5 and 11 years took part: 200 attended for routine dental care (RDC); the remaining 400 attended as emergency patients and were offered either dental general anaesthesia (DGA) or Relative Analgesia (RA). The subjects were approached and invited to take part. The researcher was blind as to the child's pattern of dental attendance and the type of sedation offered. All parents and children completed self-reported ratings of dental anxiety. The children's teeth were examined to determine past and present dental caries experience. Results: The results showed that children who were offered DGA had greater experience of dentinal caries, were younger and dentally anxious. The children offered RA were older, had a higher frequency of brushing their teeth with fluoride toothpaste and were also dentally anxious. Discriminant analysis showed that 2 canonical functions provided clear categorisation of the three treatment groups. Function 1 was a physical (dental caries) factor, which was related to the child's experience of dentinal caries. Function 2 was a psychosocial factor, which was related to the child's age, dental anxiety and frequency of tooth brushing. A greater proportion of the variance in the treatment offered was explained by Function 1, suggesting that the most important factor in the decision to offer DGA was dentinal caries. Function 2 was of lesser importance. Conclusions: The findings have implications for the type of sedation offered to children presenting for emergency care. These children may not otherwise receive treatment and the need to provide less anxiety provoking forms of sedation must be promoted. By doing so, parents who have only brought their children when in pain may take advantage of RDC and the treatments offered to prevent and control dental caries and anxiety in their children.
P. A. Averley - One of the best experts on this subject based on the ideXlab platform.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment--an alternative to general anaesthesia
British dental journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 (n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 (n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 (n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment — an alternative to general anaesthesia
British Dental Journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Intravenous sedation in combination with inhaled nitrous oxide or inhaled nitrous oxide and sevoflurane provides a safe alternative to general anaesthesia in anxious paediatric dental patients. With the appropriate staff, training and facilities, these conscious sedation techniques may be safely used in a 'non hospital setting' without the risk of 'deep sedation' or anaesthesia. It is essential that future research in the field of paediatric conscious sedation be carried out in the United Kingdom. Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 ( n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 ( n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 ( n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ^2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane.
Anaesthesia, 2004Co-Authors: P. A. Averley, N. M. Girdler, Senga Bond, N. Steen, Jimmy SteeleAbstract:Failure of dental treatment due to anxiety is a common problem in children. The aim of this study was to establish whether the use of a combination of intravenous midazolam with inhalation agents (nitrous oxide alone or in combination with sevoflurane) was any more likely to result in successful completion of treatment than midazolam alone. A further aim was to evaluate the clinical viability of these techniques as an alternative to general anaesthesia. In total, 697 children too anxious for management with Relative Analgesia and requiring invasive dental procedure for which a general anaesthetic would usually be required, were recruited and randomly assigned to one of three groups given the following interventions: group 1 - a combination of inhaled medical air and titrated intravenous midazolam, group 2 - a combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam, and group 3 - a combination of an inhaled mixture of sevoflurane 0.3% and nitrous oxide 40% in oxygen with titrated intravenous midazolam. The primary outcome measure was successful completion of the intended dental treatment with a co-operative child responsive to verbal commands. In group 1, 54% (94/174 children) successfully completed treatment. In group 2, 80% (204/256 children) and in group 3, 93% (249/267 children) completed treatment. This difference was significant at the 1% level. Intravenous midazolam, especially in combination with inhaled nitrous oxide or sevoflurane and nitrous oxide, are effective techniques, with the combination of midazolam and sevoflurane the one most likely to result in successful treatment.
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Sevoflurane inhalation conscious sedation for children having dental treatment
Anaesthesia, 2001Co-Authors: G. Y. G. Lahoud, P. A. Averley, M. R. HanlonAbstract:An audit at the Queensway Anxiety Management Clinic of 2014 children, referred for dental treatment, showed that Relative Analgesia by inhalation of nitrous oxide and oxygen failed in 40% of cases successfully to complete treatment. We therefore investigated the efficacy of a new inhalation conscious sedation technique, which reduced the need for general anaesthesia. Seventy-five children aged 3-15 years were given inhalation conscious sedation, with sevoflurane 0.1-0.3% and nitrous oxide 40% in oxygen. In 69 children (92%), the dental treatment was completed successfully. Most children (93%) had recovered fully within 10 min without side-effects. Treatment was fully accepted by 88% of children and 91% of their parents. The use of sevoflurane in low concentrations to supplement nitrous oxide and oxygen for conscious sedation in children appears to be safe and effective and further study is currently in progress.
N. M. Girdler - One of the best experts on this subject based on the ideXlab platform.
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Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K.
SAAD digest, 2011Co-Authors: Darren Hand, John Lyne, Paul Averley, N. M. GirdlerAbstract:BACKGROUND Child dental anxiety is widespread, and it is not always possible to treat children using traditional methods such as behavioural management, local anaesthesia and even Relative Analgesia. In such cases a dental general anaesthetic (DGA) is the only option available to facilitate dental treatment in anxious children. AIM This study describes an advanced conscious sedation protocol which allows invasive treatment to be carried out in anxious children. It incorporates the use of titrated intravenous midazolam and fentanyl and inhalation agents, sevoflurane and nitrous oxide/oxygen, which is administered by a Consultant Anaesthetist. The aim is to produce an evidence- based study which can offer a sedation technique as a safe and effective alternative to a DGA. STUDY DESIGN Retrospective audit. METHOD 267 clinical records were audited retrospectively from a specialist sedation-based clinic, for children aged 5-15 years old. The subjects all underwent invasive dental procedures with this technique between August and November 2008 as an alternative to a DGA. RESULTS 262/267 (98%) of the subjects were treated safely and successfully and without the loss of verbal communication using this technique. This included many treatments requiring four quadrant dentistry, with both restorations and extractions as necessary being carried out in one visit. 5 subjects (2%) did not tolerate treatment and had to be referred for a DGA. No medical emergencies occurred. CONCLUSIONS Based on the evidence for this group of patients, this advanced conscious sedation technique, offers a safe and effective alternative to DGA. This technique must be carried out in an appropriate environment by an appropriately trained and experienced team who are able to comply with the recommendations for "alternative" sedation techniques.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment--an alternative to general anaesthesia
British dental journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 (n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 (n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 (n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment — an alternative to general anaesthesia
British Dental Journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Intravenous sedation in combination with inhaled nitrous oxide or inhaled nitrous oxide and sevoflurane provides a safe alternative to general anaesthesia in anxious paediatric dental patients. With the appropriate staff, training and facilities, these conscious sedation techniques may be safely used in a 'non hospital setting' without the risk of 'deep sedation' or anaesthesia. It is essential that future research in the field of paediatric conscious sedation be carried out in the United Kingdom. Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 ( n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 ( n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 ( n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ^2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane.
Anaesthesia, 2004Co-Authors: P. A. Averley, N. M. Girdler, Senga Bond, N. Steen, Jimmy SteeleAbstract:Failure of dental treatment due to anxiety is a common problem in children. The aim of this study was to establish whether the use of a combination of intravenous midazolam with inhalation agents (nitrous oxide alone or in combination with sevoflurane) was any more likely to result in successful completion of treatment than midazolam alone. A further aim was to evaluate the clinical viability of these techniques as an alternative to general anaesthesia. In total, 697 children too anxious for management with Relative Analgesia and requiring invasive dental procedure for which a general anaesthetic would usually be required, were recruited and randomly assigned to one of three groups given the following interventions: group 1 - a combination of inhaled medical air and titrated intravenous midazolam, group 2 - a combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam, and group 3 - a combination of an inhaled mixture of sevoflurane 0.3% and nitrous oxide 40% in oxygen with titrated intravenous midazolam. The primary outcome measure was successful completion of the intended dental treatment with a co-operative child responsive to verbal commands. In group 1, 54% (94/174 children) successfully completed treatment. In group 2, 80% (204/256 children) and in group 3, 93% (249/267 children) completed treatment. This difference was significant at the 1% level. Intravenous midazolam, especially in combination with inhaled nitrous oxide or sevoflurane and nitrous oxide, are effective techniques, with the combination of midazolam and sevoflurane the one most likely to result in successful treatment.
Senga Bond - One of the best experts on this subject based on the ideXlab platform.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment — an alternative to general anaesthesia
British Dental Journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Intravenous sedation in combination with inhaled nitrous oxide or inhaled nitrous oxide and sevoflurane provides a safe alternative to general anaesthesia in anxious paediatric dental patients. With the appropriate staff, training and facilities, these conscious sedation techniques may be safely used in a 'non hospital setting' without the risk of 'deep sedation' or anaesthesia. It is essential that future research in the field of paediatric conscious sedation be carried out in the United Kingdom. Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 ( n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 ( n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 ( n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ^2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment--an alternative to general anaesthesia
British dental journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 (n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 (n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 (n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane.
Anaesthesia, 2004Co-Authors: P. A. Averley, N. M. Girdler, Senga Bond, N. Steen, Jimmy SteeleAbstract:Failure of dental treatment due to anxiety is a common problem in children. The aim of this study was to establish whether the use of a combination of intravenous midazolam with inhalation agents (nitrous oxide alone or in combination with sevoflurane) was any more likely to result in successful completion of treatment than midazolam alone. A further aim was to evaluate the clinical viability of these techniques as an alternative to general anaesthesia. In total, 697 children too anxious for management with Relative Analgesia and requiring invasive dental procedure for which a general anaesthetic would usually be required, were recruited and randomly assigned to one of three groups given the following interventions: group 1 - a combination of inhaled medical air and titrated intravenous midazolam, group 2 - a combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam, and group 3 - a combination of an inhaled mixture of sevoflurane 0.3% and nitrous oxide 40% in oxygen with titrated intravenous midazolam. The primary outcome measure was successful completion of the intended dental treatment with a co-operative child responsive to verbal commands. In group 1, 54% (94/174 children) successfully completed treatment. In group 2, 80% (204/256 children) and in group 3, 93% (249/267 children) completed treatment. This difference was significant at the 1% level. Intravenous midazolam, especially in combination with inhaled nitrous oxide or sevoflurane and nitrous oxide, are effective techniques, with the combination of midazolam and sevoflurane the one most likely to result in successful treatment.
N. Steen - One of the best experts on this subject based on the ideXlab platform.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment — an alternative to general anaesthesia
British Dental Journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Intravenous sedation in combination with inhaled nitrous oxide or inhaled nitrous oxide and sevoflurane provides a safe alternative to general anaesthesia in anxious paediatric dental patients. With the appropriate staff, training and facilities, these conscious sedation techniques may be safely used in a 'non hospital setting' without the risk of 'deep sedation' or anaesthesia. It is essential that future research in the field of paediatric conscious sedation be carried out in the United Kingdom. Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 ( n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 ( n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 ( n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ^2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment--an alternative to general anaesthesia
British dental journal, 2004Co-Authors: P. A. Averley, N. M. Girdler, N. Steen, I Lane, J Sykes, Senga BondAbstract:Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care. Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement. Design Single centre, randomised control trial (RCT). Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients. Subjects, materials and methods Sixty five children too anxious for management with Relative Analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found. Interventions Group 1 (n = 20) — A combination of inhaled medical air and titrated intravenous midazolam. Group 2 (n = 22) — A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 (n = 23) — A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam. Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands. Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (χ2 = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique. Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
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A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane.
Anaesthesia, 2004Co-Authors: P. A. Averley, N. M. Girdler, Senga Bond, N. Steen, Jimmy SteeleAbstract:Failure of dental treatment due to anxiety is a common problem in children. The aim of this study was to establish whether the use of a combination of intravenous midazolam with inhalation agents (nitrous oxide alone or in combination with sevoflurane) was any more likely to result in successful completion of treatment than midazolam alone. A further aim was to evaluate the clinical viability of these techniques as an alternative to general anaesthesia. In total, 697 children too anxious for management with Relative Analgesia and requiring invasive dental procedure for which a general anaesthetic would usually be required, were recruited and randomly assigned to one of three groups given the following interventions: group 1 - a combination of inhaled medical air and titrated intravenous midazolam, group 2 - a combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam, and group 3 - a combination of an inhaled mixture of sevoflurane 0.3% and nitrous oxide 40% in oxygen with titrated intravenous midazolam. The primary outcome measure was successful completion of the intended dental treatment with a co-operative child responsive to verbal commands. In group 1, 54% (94/174 children) successfully completed treatment. In group 2, 80% (204/256 children) and in group 3, 93% (249/267 children) completed treatment. This difference was significant at the 1% level. Intravenous midazolam, especially in combination with inhaled nitrous oxide or sevoflurane and nitrous oxide, are effective techniques, with the combination of midazolam and sevoflurane the one most likely to result in successful treatment.