Complications associated with intravenous midazolam sedation in anxious dental patients.

AIM: This prospective study was designed to establish the nature, frequency and sequelae of complications arising in patients receiving dental treatment under intravenous midazolam sedation. METHODS: All patients attending the Sedation Department at New-castle Dental Hospital for intravenous sedation over a six-month period were audited. A standardised data-collection pro forma was designed in order to collect data relating to the patient, the sedation episode, the dental treatment and any complications arising. The published standard used in this study states that the incidence of complications should be no more than 8%. RESULTS: Four hundred and one patients were included. The mean dose of midazolam administered was 7.6 mg with a mean titration rate of 0.9 mg/min. Complications were reported in 12 patients (3%), 11 of which were minor and one moderate. All complications were managed successfully within the department with no lasting sequelae. Treatment was completed in 382 (95.7%) patients, with failure to complete treatment in 17 (4.3%) patients due to disinhibition (1), poor cooperation (10), and the sedation wearing off (6). CONCLUSION: The standard was met because complications arising were infrequent (3%) and predominantly minor in nature. Complications were managed conservatively and effectively, with all patients being discharged home the same day with no lasting sequelae. The study demonstrates that intravenous midazolam provides a safe sedation technique, suitable for adult dental patients in primary care, when administered by trained personnel on carefully selected patients and in accordance with nationally agreed protocols and guidelines.

An audit of patient referrals to the sedation department of Newcastle Dental Hospital.

AIM: To audit the quality of external referral communications sent to the Department of Sedation at Newcastle Dental Hospital. METHODS: A retrospective analysis was undertaken of a sample of 226 consecutive external referrals received by the sedation department of Newcastle Dental Hospital during May-July 2008. A data-collection form was used to record information provided in referrals relevant to the practice of sedation and the set standard was based on the recommendations of the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: Of the 226 referrals sampled, the majority (222; 98.2%) were from general dental practitioners. Seventy-six per cent were by letter and 24% by pro forma. Although of particular relevance to sedation referrals, a medical history was provided in only 59.0% of referrals and details of previous dental treatment in only 27.5%. The use of a pro forma significantly increased the provision of information compared to a letter in the following areas: patient's telephone number, patient's medication, doctor's name and doctor's address. Significantly less information was provided in the pro forma compared to the letters concerning the name of the referring practitioner and referring practitioner's telephone number. No difference was found between letter and pro forma referrals for medical history, treatment already attempted and reason for referral. CONCLUSIONS: The findings indicate a need to improve the amount of information provided in referrals to the sedation department of Newcastle Dental Hospital in order to ensure appropriate allocation to sedation services. The quality of referrals may be improved by the distribution of referral guidelines, the use of electronic referral templates or changes to the current pro forma.