Conscious sedation is a minimally depressed level of consciousness using drugs like nitrous oxide and oxygen mixtures, fentanyl, diazepam or midazolam to relieve anxiety while maintaining the patient's ability to independently maintain their airway and respond to verbal commands. It has objectives of keeping vital signs stable, making the patient cooperative while conscious, increasing their pain threshold, and providing amnesia. It is commonly used for uncooperative or anxious patients and can be delivered enterally, parenterally, transdermally or via inhalation with monitoring of oxygen levels, ventilation and vital signs. Nitrous oxide is often used due to its rapid onset and recovery through 4 phases.

1. CONSCIOUS
SEDATION
Prince Dhingra
B.D.S. Final Year
J.C.D. Dental College
Sirsa(Haryana)

2. CONTENTS
• INTRODUCTION
• What is Conscious Sedation
• Objectives of Conscious sedation
• Indications
• Routes used for conscious sedation
• Drugs used for conscious sedation
• Monitoring
• Nitrous Oxide and phases of its administration
• Fasting Guidelines
• Contraindications
• Adverse Effects

3. • A minimally depressed level of
consciousness, that retains
patient’s ability to maintain an
airway independently and
respond appropriately to
physical stimulation and verbal
command.
{ADA(1993)}
Definition of Conscious Sedation

4. Reference From: Illustrated Paedriatic Dentistry
By PR Chockalingam

5. Objectives
Of Conscious
Sedation
Vital Signs
stable and
normal.
Patient should be
cooperative.
Patient should
be conscious,
respond to
verbal stimuli.
The patient’s
mood should be
altered
Amnesia
should occur.
Child’s pain
threshold
should be
increased
All protective
Reflexes intact

6. Indications
UNCOOPERATIVE
PATIENT
Patients with lack
of
pschychological
or emotional
maturity.
FEARFUL AND
ANXIOUS
PATIENT

7. Routes used for conscious
sedation
Enteral
Parenteral
Transdermal
Transmucosal
Inhalation

8. Drugs used for conscious
Sedation
• Nitrous oxide and oxygen mixture
• Fentanyl
• Diazepam
• Propofol
• Midazolam

9. Monitoring
Oxygen saturation must be evaluated by
pulse oximetry
The Dentist must monitor ventilation and/or
breathing
Blood pressure and heart rate must be
evaluated
E.C.G. monitoring

10. Nitrous Oxide and Oxygen
Nitrous oxide is most commonly used drug
because of its rapidity of onset and the rapidity
of recovery.
It has 4 phases of Administration;

11. Phase Objectives/Events Gases Administered at
relative Analgesia
Induction Phase Introduction, explanation and
instructions of the procedure
100% Oxygen,3-5 L/min for 3
minutes
Injection
Phase
To obtain sedation while
suggesting positive thoughts
•Rapid mode:21/2 Litre each of
N2O2 and O2 for 6-8 minutes
•Slow mode:0.5 L of N2O2
with an incremental increase
of 0.5 L to a level of 21/2 L
with a corresponding
decrease in oxygen for 11 to
13 minutes.
Maintenance
Phase
Maintain the depth of
sedation and state of
analgesia.
1-2 litre of Nitrous Oxide and
3-4 L of oxygen(25:75-40:60
concentration)
Withdrawal
Phase
Obtain complete recovery. 100% oxygen for 3-11
minutes,5 L of oxygen per
minute

12. INDUCTION
PHASE
INJECTION
PHASE
MAINTENANCE
PHASE
WITHDRAWAL
PHASE

13. Fasting Guidelines given by American
Society Anaesthesiologists
INGESTED MATERIAL MINIMUM FASTING
PERIOD
Clear Liquids 2 hours
Breast Milk 4 hours
Infant Formula 6 hours
Nonhuman milk 6 hours
Light Meal 6 hours
Fatty Meal 8 hours

14. Contraindications
Dental
difficulties,
prolonged
surgery,
inadequate
personnel.
Unwilling,
unaccompanied
patients.
Chronic obstructive
pulmonary
disorder(COPD),
pregnancy,
myasthenia,
epilepsy, obesity,
bleeding disorders.

15. CONSCIOUS SEDATION GENERAL ANAESTHESIA
At several visits the procedure may be
performed
Generally a single sitting, once in a lifetime
Procedure
Patient is cooperative, but anxious
and fearful
Patient is uncooperative
Generally no extensive investigations
are required
No premedication is required either
Atleast basic investigations are a must
Premedication is also required
Patient is conscious and contact is
maintained
Ventillation is required
Airway is maintained
No mortality 99% success rate reported
Recuperation period is 1-2 minutes Time Consuming procedure
Patient feels he is in control of the
situation
Patient cannot control the situation

16. Nausea
and
Vomiting
Diffusion
Hypoxia
Adverse
Effects

17. Conclusion
Nitrous oxide and oxygen is a safe and effective
technique to reduce anxiety, produce analgesia
and enhance effective communication between
Patient and operator. It increases patient’s pain
threshold. It must be used in pediatric patient
and uncooperative patient.

18. REFERENCES
• Dentistry for the Child and Adolescent by
McDonald,Avery,Dean
• Textbook of Oral and Maxillofacial Surgery
by Daniel M. Laskin
• Essentials of Pharmacology for Dentistry By
KD Tripathi
• Illustrated Paedriatic Dentistry By
PR Chockalingam