Conscious sedation is a technique used to relax patients for dental procedures while keeping them awake. The most common method is nitrous oxide delivered via nasal hood. Characteristics of conscious sedation include the patient remaining awake but impaired. Children are more easily sedated than adults. Risks include unintended loss of consciousness. Evaluation of patients includes medical history, physical exam, and determining ASA class. Preparations include instructions, fasting, and having a responsible adult. Techniques include inhalation of nitrous oxide, intravenous drugs, and oral drugs. Proper equipment and monitoring of sedation levels is important. Post-sedation instructions warn against driving or operating machinery for 18 hours.

1. ConsciousSedation
inDentistry
Dr. Abdullah Ashraf
page 1

2. Introduction
page 2
Conscious sedation is a state of mind achieved by combination of
medicines to help you relax (a sedative) for medical or dental
procedure.
You will probably stay awake, but may not be able to speak.
The most popular method is:
Sedation by the inhalation of nitrous oxide is frequently the
technique of choice for anxious patients and may be the only
technique required for many patients who have mild to moderate
anxiety.

3. Characteristicsofconscioussedation
page 3
1. Patient remains awake.
2. They remain responsive to stimuli such as verbal commands.
3. Child can easily slip from one sedation level to another.
4. Anatomical and physiological exist between adults and children.
5. All of the patient’s reflexes remain intact. (breathing, coughing)
6. Cognitive functions are impaired (reasoning, perception,
comprehension).
7. Patient easily awaken when dose is off.

4. LevelsofSedation
page 4

5. Indications
page 5
1. Anxious/phobic patients usually children and people with high fear
susceptibility.
2. Patients with movement disorders with physical and mental
defects.
3. Patients with severe gag reflex.
4. Prolong unpleasant procedures. e.g. Surgical Extraction of 3rd
molars.
5. To avoid risk related to General anesthesia.
6. Medical conditions aggravated by stress.
7. Medical conditions affecting pt. ability to cooperate
8. Special needs.

6. Contraindications
page 6
1. COPD, epilepsy, bleeding disorders
2. Uncooperative or unwilling patients.
3. Unaccompanied patients
4. Prolong surgery.
5. Lack of equipment
6. Lack of operator skill.
7. ASA, class 3 or 4.
8. Airway abnormity.
9. Severe obesity.
10.Obstructive sleep apnea (OSA).
11.Raised intracranial pressure or acute trauma.

7. ConsciousSedation:Howisitachieved?
page 7
It can be achieved by one of the following methods:
1. Inhalation Techniques – NO2 and O2.
2. Parenteral IV administration of sedative drugs.
3. Oral/ transmucosal drugs.
4. Combination of above.
The above techniques should carry a margin of safety wide enough not
render loss of consciousness.

8. Sedationinchildren
page 8
1. They receive more CS than adults.
2. Their sedation level must be kept deeper than adults.
3. Child can easily slip from one sedation level to another
4. Anatomical and physiological exist between adults and children.

9. RisksinvolvedinSedation
page 9
1. Unintentional loss of consciousness.
2. Depression of airway.
3. Depression of CVS and Respiratory system.
4. Nausea.
5. Hypoxia.
6. Hyperactivity.

10. PreSedationPatientEvaluation
page 10
• General History
(Medical and dental, age, state of health and socio-economic
status, family history)
Relevant history:
1. Weight
2. Drug allergies
3. On going medications.
4. Previous illness
5. Current illness
6. Previous sedation experience and the drugs used for it.

11. Physicalexamination
page 11
1. Airway structural abnormalities.
2. Respiratory Rate and oxygen saturation.
3. Heart Rate.
4. Blood Pressure.
5. Determine ASA Class.
6. Level of consciousness.

12. PatientPreparations
page 12
1. Give verbal and written instructions to patient regarding effects of
sedation.
2. Fasting before sedation is not required unless there is a marked
gag reflex. 6-8 hours fasting can be advised.
3. Advise to avoid alcohol and large meals on the day of surgery.
4. There must be a responsible adult accompanying patient.
5. A valid informed consent must be taken before procedure.
6. Nothing to drink or eat 2 hours before procedure.
7. Make a trip to washroom just prior to being seated.

13. SedationTechniques

14. SedationTechniques
page 14
1. Inhalation Technique
 Nitrous Oxide is first choice of inhalational sedation technique.
 It is titrated to oxygen along with individual response.
 Employed and delivered via inhalational machine.
2. Intravenous Technique
 Only appropriate in fewer cases.
 Drug used: Midazolam, Diazepam and other benzodiazepines
 When to use: If inhalational technique is unsuccessful
 Topical anesthesia is applied on local area prior to administration of
drugs.
3. Oral/transmucosal Technique
 May be used in anxious patient prior to treatment.
 May be prescribed to assit with sleep after treatment.
 Drugs: Diazepam, Lorazepam

15. Inhalation Technique
page 15
Nitrous Oxide Sedation
 Nitrous oxide is an odorless and colorless gas that is not irritating to
airways.
 It is toxic to humans if given in very high concentrations, but, when
properly mixed with pure oxygen and given appropriately, it can be
an extremely potent analgesic and anxiolytic.
 Patients who cannot handle mind-altering drugs are poor candidates
for nitrous oxide.
 Claustrophobic patients may not be able to tolerate a nasal hood.
 Avoid the use of nitrous oxide during the first trimester in pregnant
patients.

16. Inhalation Technique
page 16
General Protocol for Using Nitrous Oxide
 Begin with giving the patient 100% oxygen.
 The clinician should check for proper mask adaptation to the patient’s face.
 After a few minutes of preoxygenation, the amount of flows should be
adjusted to 20%/80% N2O:O2 mix.
 After 2 minutes ask patient for any mood change. If everything is good then
adjust the mix to 30%:70% N2O:O2.
 Again, after 2 minutes ask patient for any mood change. Good or bad?
 If bad, the percentage of N2O should be lowered to 25%, and after 2
minutes ask again.
 If, it is still bad the patient cannot tolerate even low levels of N2O and the
attempt at inhalation sedation should be ended.

17. Inhalation Technique
page 17
General Protocol for Using Nitrous Oxide (contd.)
 If patient feels no effect at 30% of N2O.
 Raise the N2O percentage to 35%. Ask after 2 minutes, If response is
positive then proceed to local anesthesia and surgery.
 You can lower the N2O concentration to 32% or 33% to try to fine-tune the
sedative effects.
 Do not use N2O above 50%
 Dentist should regularly check that the patient is still relaxed and feeling
good.
 Once the need for sedation ends and the patient is placed on 100% oxygen
for about 5 minutes to recover.
 Monitor carefully at every step.

18. Equipment
page 18

19. Equipment
page 19
(A)Nasal hood that patient
wears when receiving
nitrous oxide sedation.
Note that during
exhalation the expired air is
vacuumed through a one-
way valve into the
scavenging system.
(B) Nasal hood designed to
deliver oxygen and nitrous
oxide and remove expired
air.
(C) Nasal hood connected
to tubing that then connects
to the O2-N2O feeder
tubing and the scavenging
tubing.

20. Minimal Sedation
• Appointment of 2 hours or less.
 Triazolam- 0.125 to 0.25mg
Appointment longer than 2 hours
 Triazolam 0.25mg
 Diazepam 10-15mg
 Oxazepam 10-15mg
 Temazepam 15mg
Appointment longer than 3 hours
 Lorazepam 0.5-1mg
 Alprazolam 0.25mg
Suggested dosage for Oral Sedation
page 20
• Appointment of 2 hours or less.
 Triazolam- 0.375 to 0.50mg
Appointment longer than 2 hours
 Triazolam 0.50mg
 Diazepam 20-30mg
 Oxazepam 20-30mg
 Temazepam 30mg
Appointment longer than 3 hours
 Lorazepam 2-3mg
 Alprazolam 0.50mg
Moderate Sedation

21. Advantages
Inhalational/ IV sedation can be
titrated as required at given time.
Parenteral Sedation Technique
page 21
Special instrument required
Special training required
Not cost effective
Disadvantages

22. Advantages
Easily administered
Less technique sensitive
Relatively safe as it is non invasive
Cost effective
Good patient acceptance
Oral Sedation Technique
page 22
Inability to titrate
Delayed and variable onset of
actions
Patient must be accompanied
home
Excessive effect and duration in
elderly
Limited success in children
Disadvantages

23. Patientinstructions:Aftersedation
page 23
1. You must not drive or operate machinery for at least 18 hours after
procedure.
2. Do not travel by public transit.
3. Do not drink alcoholic beverages for rest of the day.
4. If there is any problem, call the dentist incharge.

24. page 24
Thankyou!