A survey of general anaesthesia and sedation in dental practice in two cities

Using a postal questionnaire, the use of general anaesthesia and sedation in general dental practice in two cities over a 4-week period was investigated. Questionnaires were sent to a random sample of one in five dental practitioners in Bristol and Sheffield, and an 82% response rate was attained. More practices in Sheffield administered general anaesthesia than those in Bristol. The differences between the facilities provided are discussed. Equipment and facilities have improved since a larger survey was described in 1976, but the use and availability of monitoring equipment has changed little since then. The results reflect the decline in the use of general anaesthesia in dental practice seen nationally. The survey provides an insight into the current anaesthetic services provided in general dental practice in two cities, both of which contain dental hospitals, and provides a basis for the design of a protocol for a further national survey.     

Midazolam sedation in the general dental practice

The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment.     

General dental practitioner's views on dental general anaesthesia services

OBJECTIVE: Policy has recently changed on provision of dental general anaesthetic services in England. The aim of this study was to investigate general dental practitioners' views about dental general anaesthetics, the reduction in its availability and the impact on care of children with toothache. RESEARCH DESIGN: Qualitative study using semi-structured interviews and clinical case scenarios. PARTICIPANTS: General dental practitioners providing NHS services in the North West of England. RESULTS: 93 general dental practitioners were interviewed and 91 answered a clinical case scenario about the care they would provide for a 7-year-old child with multiple decayed teeth presenting with toothache. Scenario responses showed variation; 8% would immediately refer for general anaesthesia, 25% would initially prescribe antibiotics, but the majority would attempt to either restore or extract the tooth causing pain. Interview responses also demonstrated variation in care, however most dentists agree general anaesthesia has a role for nervous children but only refer as a last resort. The responses indicated an increase in inequalities, and that access to services did not match population needs, leaving some children waiting in pain. CONCLUSIONS: Most general dental practitioners support moving dental general anaesthesia into hospitals but some believe that it has widened health inequalities and there is also a problem associated with variation in treatment provision. Additional general anaesthetic services in some areas with high levels of tooth decay are needed and evidence based guidelines about caring for children with toothache are required.     

Retrograde amnesia after intravenous sedation and general anaesthesia in a dental hospital

Midazolam, a benzodiazepine, is commonly used for intravenous sedation for dental procedures and, together with other benzodiazepines, can cause anterograde amnesia. Retrograde amnesia, however, is rare. It is defined as a loss of access to memory of events that occurred, or information that was learned, before the injury or event that caused the amnesia. We know of no reports of this occurring after the intravenous use of midazolam alone and few after general anaesthesia. We present two cases of retrograde amnesia: one after intravenous sedation and one after general anaesthesia.     

General anaesthesia, sedation and resuscitation in dentistry.

In the eyes of the public there is a traditional link between general anaesthesia and dental practice. After 150 years' experience the link may be broken by Government's acceptance of the Poswillo Report and its major recommendations.     

Utilization of personal protective equipment in general dental practice

The principles of universal precautions are central to infection control. These principles form the basis of current guidelines for the use of personal protective equipment (PPE) in dental practice. This study, which examined the patterns of use of PPE in general dental practice, was based on a postal survey of 260 dentists in Brisbane (41 per cent of the total private general practitioners in the region). Routine use of PPE was commonplace (gloves, 84.6 per cent; masks, 55.7 per cent; eyewear, 77.6 per cent), but complete compliance with current recommendations for glove handling and hand care had not been achieved. Potential problem areas in terms of attitudes to PPE were identified, as were inconsistencies in the use of PPE in both clinical and non-clinical settings. These findings emphasize the need for further educational campaigns In practical infection control measures.     

Propofol sedation in general dental practice: the first 100 patients

Experience is presented of the treatment of 100 patients for routine dentistry in general dental practice under propofol (Diprivan) sedation, delivered by continuous infusion. The infusion rates were set manually according to patients' responses. There were no differences in dental treatment or propofol requirements according to gender. Propofol requirements in some cases exceeded the upper limit of the recommended dose ranges and reasons why this may have occurred are discussed. A most useful feature of propofol sedation was the associated rapid recovery, with no patients needing to remain in the surgery for the purposes of recovery. The technique met with patients' approval, as all responses returned indicated a willingness to undergo the same type of sedation in future. Propofol sedation is not appropriate for the single operator/sedationist.     

Medical emergencies in dental practice and choice of emergency drugs and equipment: A survey of Australian dentists

This is a report of a postal questionnaire survey of 1250 general dental practitioners regarding occurrence of medical emergencies and their choice of emergency drugs and equipment. The response rate was 65 per cent and the results showed that about one in seven practitioners had had to resuscitate a patient. The most common medical emergencies were adverse reactions to local anaesthetics, grand mal seizures, angina pectoris and hypoglycaemia (insulin shock). Nearly all respondents (96 per cent) believed that dentists need to be competent in cardiopulmonary resuscitation, just over a half (55 per cent) felt they were competent in CPR on graduation and a similar, figure (57 per cent) felt they could perform effective single person CPR for five minutes. Almost twothirds (64 per cent) had undertaken CPR courses since graduation. Additionally, the most commonly kept emergency drugs were oxygen (63 per cent) and adrenaline (22 per cent), while the most commonly kept emergency equipment was a manual resuscitator (recoil bag-valve-mask type) which was kept by 27 per cent of the practitioners.