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Background: Delirium is common after hip fracture surgery, affecting up to 50% of patients. The incidence of delirium may be influenced by mode and conduct of anaesthesia. We examined the effect of spinal anaesthesia (with and without sedation) compared with general anaesthesia on early outcomes following hip fracture surgery, including delirium.Methods: We used prospective data on 107,028 patients (2018 to 2019) from the National Hip Fracture Database, which records all hip fractures in patients aged 60 years and over in England, Wales and Northern Ireland. Patients were grouped by anaesthesia: general (58,727; 55%), spinal without sedation (31,484; 29%), and spinal with sedation (16,817; 16%). Outcomes (4AT score on post-operative delirium screening; mobilisation day one post-operatively; length of hospital stay; discharge destination; 30-day mortality) were compared between anaesthetic groups using multivariable logistic and linear regression models.Results: Compared with general anaesthesia, spinal anaesthesia without sedation (but not spinal with sedation) was associated with a significantly reduced risk of delirium (odds ratio (OR)=0.95, 95% confidence interval (CI)=0.92-0.98), increased likelihood of day one mobilisation (OR=1.06, CI=1.02-1.10) and return to original residence (OR=1.04, CI=1.00-1.07). Spinal without sedation (p<0.001) and spinal with sedation (p=0.001) were both associated with shorter hospital stays compared with general anaesthesia. No differences in mortality were observed between anaesthetic groups.Conclusions: Spinal and general anaesthesia achieve similar outcomes for patients with hip fracture. However, this equivalence appears to reflect improved perioperative outcomes (including a reduced risk of delirium, increased likelihood of mobilisation day one post-operatively, shorter length of hospital stay and improved likelihood of returning to previous residence on discharge) among the sub-set of patients who received spinal anaesthesia without sedation. The role and effect of sedation should be studied in future trials of hip fracture patients undergoing spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Conscious sedation has a very important role in the field of dentistry as it can facilitate safe dental care. It can reduce the unpleasant experience of a procedure and facilitate improved patient co-operation. Sedation was made more important after 2000 when general anaesthesia was no longer available in primary care following the publication of'A Conscious Decision' by the Department of Health, England. In the UK, intravenous midazolam and inhalation sedation with nitrous oxide are commonly used sedative agents administered as single agents. They have not been routinely practised in combination, or in combination with other sedative agents. There are, however, gaps in the evidence to address the benefits of their combined use and thus there is a need to explore the efficacy of the combination of intravenous midazolam and nitrous oxide inhalation sedation. There is also a need to increase recognition and training of their combined use. This article aims to address the question of: 'How effective is the concomitant use of N2O with IV midazolam for conscious sedation?. [ABSTRACT FROM AUTHOR]

The General Dental Council (GDC) and the Dental Sedation Teachers Group (DSTG) define intravenous sedation (IVS) as: 'A technique in which the use of a drug or drugs produces a state of depression of the central nervous system (CNS) enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout'. This article discusses a retrospective analysis of an on-going rolling audit evaluation carried out from 2016 to 2020 across the Community Dental Services (CDS) in northwest England. This project identifies any complications of IVS recorded. Identifying complications allowed the recognition of further training needs, such as further training on incident reporting and revision of clinical skills. The complications of IVS include: failed sedation, drop in oxygen saturation, over sedation and the use of any reversal agent. The purpose of this retrospective analysis is to review the compliance within the CDS with the Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) Report: Standards for Conscious Sedation in the Provision of Dental Care 2015. Taking a practical and pragmatic approach, the local standard selected within this retrospective analysis of complication rates was of less than 5%. Across the four-year period, the results show the CDS had an average complication rate of 2% which meets the standard set. In conclusion: monitoring these complications and highlighting patterns improves patient safety and overall outcomes. This provides a learning opportunity for clinicians if a repeated pattern of complication is identified. The data collected has shown satisfactory record keeping and low complication numbers throughout the four-year period of Trust scrutiny. The most recent audit data discussed in this review, considers the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its effect on the provision of IVS and associated complication rates. [ABSTRACT FROM AUTHOR]

Introduction The General Dental Council (GDC) expects dental professionals to manage patients' dental anxiety and pain appropriately. Conscious sedation (CS) offers a safe alternative to general anaesthesia for patients who are unable to tolerate routine dental care. Current guidelines [Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD), NHS England and Scottish Dental Effectiveness Clinical Programme (SDCEP)] recommend high-quality documentation of patient assessments including sedation history and airway assessment before undertaking CS. Alm To ensure high standards of record-keeping for pre-sedation assessments to allow safe provision of CS. Methods A clinical audit, where written patients' records were examined against the standard, contributed to an action plan detailing improvement to the current practice. After implementing the action plan from the first cycle, a second audit was undertaken to ensure compliance. Results In the second audit cycle, although only 11 (27%) records used the stamp checklist (one of the recommendations from the first cycle), the documentation of the airway assessment showed a slight improvement (64% to 73 %), whereas the documentation of a sedation history improved greatly (39% to 80%). Conclusion The results demonstrated the need to increase awareness of high quality record keeping through repeated clinical audit cycles/spirals involving the stakeholders in the suggested improvement plans. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the Dental Sedation Teachers Group (DSTG) Annual Symposium held at the Maritime Museum, Albert Dock in Liverpool, England on May 10, 2011. New perspectives on teaching conscious sedation was the theme chosen for this year's symposium. Paul Avery, member of the Oral Health Advisory Group, issued a warning on the negative consequences of sedation failure. Anna-Maria Rollin presented a historical overview of dental anaesthesiology.

Introduction Conscious sedation for young patients continues to be challenging. Few studies have shown positive results using intravenous midazolam when sedating young patients. This case series reports an investigation of conscious sedation using intravenous midazolam for young patients receiving dental treatment.Objective To determine acceptance, safety and efficacy of intravenous midazolam for conscious sedation in children and adolescent patients undergoing dental treatment.Patients and methods Patients from seven to 16 years of age, ASA I, II and III, opted to have extractions, minor oral surgery and/or conservative treatment with IV midazolam and local anaesthesia. A pulse oximeter was used to monitor vital signs and the Houpt scale to assess overall behaviour.Results A total of 552 patients, 234 boys and 318 girls with mean ages of 13.3 years and 13.5 years respectively, were included. Three hundred and sixty-five patients (66%) claimed to be anxious or very anxious before treatment. The average dose given was 5.7 mg and dosage ranged from 2 to 10 mg. Four hundred and fifty-seven patients (83%) scored 'very good' and 'excellent' for overall behaviour. Side-effects included crying, drowsiness and amnesia.Conclusions Intravenous midazolam is accepted by patients and is a safe and effective method of sedation for use in children and adolescents, producing some level of tearfulness. [ABSTRACT FROM AUTHOR]

Extensive research and clinical experience have demonstrated the usefulness of sedation in helping fearful patients receive dental treatment, particularly when they have urgent treatment needs. In addition, the efficacy of behavioural programmes for managing dental fears is well established. While often these two approaches are seen as oppositional, our work in Seattle, Morgantown and at King's College London Dental Institute demonstrates the complementarity of the two approaches. Using the example of two compounds, one very familiar, propranolol, and one that has recently become of interest, D-cycloserine, we wish to illustrate the manner in which these medications can be used to enhance behavioural approaches to managing dental anxiety. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of a symposium on dental sedation held by the Dental Sedation Teachers Group (DSTG) and Association of Dental Anaesthetics (ADA) at the University of Manchester Conference Centre in England in 2008. It notes that an overview of the Department of Health (DH) policy on conscious sedation was given by deputy chief dental officer Tony Jenner. It cites that a paper by Doctor Anita Jhamatt examined the thoughts of parents concerning restraint of children at induction of dental chair general anaesthesia.

Background and objectives: Desloratadine and levocetirizine are histamine H1 receptor antagonists (antihistamines) that were launched in the UK in 2001. Our objective was to compare the frequency with which drowsiness and sedation were reported for desloratadine and levocetirizine within the first 30 days of observation, as monitored using the observational cohort technique of prescription-event monitoring (PEM). Methods: Exposure data were derived from dispensed prescriptions written by primary care physicians and outcome data were derived from questionnaires that were posted to prescribers at least 6 months after the date of the first prescription for each patient. The odds ratio (OR) was calculated using unconditional logistic regression modelling. The effect of age, sex, reported prescribing indication (allergic rhinitis with asthma/wheezing, allergic rhinitis without asthma/wheezing, ‘other’), pattern of use and reported previous antihistamine use on the OR was examined. A time-to-event analysis was performed. Results: The cohorts comprised >24 000 patients in total. Cohort demographics were similar (both cohorts: median age 37 years; 60% women); the most frequently reported prescribing indication for both drugs was allergic rhinitis without asthma/wheezing (54%). The incidence of first reports of drowsiness/sedation for levocetirizine or desloratadine was low (46 [0.37%] and 9 [0.08%], respectively) and statistically different (p < 0.0001). These events tended to occur earlier for desloratadine than levocetirizine (50% at 7 or 14 days of observation, respectively; p = 0.6487), but the cumulative time to event differed, with more events observed for levocetirizine than expected (p < 0.0001; 46 vs 28.09). The final estimates of risk were the sex-adjusted ORs for each prescribing indication category: allergic rhinitis with asthma/wheezing (3.51; 95% CI 0.71, 17.43; n = 3357), allergic rhinitis without asthma/wheezing (6.75; 95% CI 2.37, 19.22; n = 12 627) and ‘other’ (3.11; 95% CI 0.86, 11.31; n = 6725). Discussion: Although the reporting rates of drowsiness and sedation are low for both drugs, patients prescribed levocetirizine are more likely to experience drowsiness and sedation in the first month of observation (after starting treatment) than patients prescribed desloratadine. For patients with allergic rhinitis without asthma/wheezing, the sex-adjusted odds of drowsiness/sedation were over six times greater in patients using levocetirizine than desloratadine in the first month of observation, with the OR being statistically significant. For the other two indication categories, allergic rhinitis with asthma/wheezing and ‘other’, the OR was not statistically significant. Conclusions: Although the risk of drowsiness/sedation is low, conditions such as allergic rhinitis are common, which makes any impact on patient cognitive function important. Doctors should be aware of this when prescribing these products to patients where daytime sedation is undesirable. However, essential components of the comparative benefit-risk evaluation of these two products include assessment of efficacy and patient preference (neither of which forms part of this study). [ABSTRACT FROM AUTHOR]

Background: Nitrous oxide was first synthesized in the 1700s. It was inhaled recreationally for the feeling of euphoria it produced. It was not until the mid-1850s that it began to be used as a dental analgesic in England. Nitrous Oxide Oxygen Inhalational Sedation technique is very popular amongst dentists abroad. However its use amongst the pediatric dentists in India still remains elusive. One reason for this being a dearth of readily available equipment used for this technique. Aim: To improve the efficiency of conscious sedation in a dental set up by making a custom made nasal hood using rubber base impression material. Material & Method: Using Vinyl Polysiloxane impression material, Plastic measuring cup & nasal tube custom made nasal hood is prepared using chair side impression technique Conclusion: This custom made nasal hood can be readily used in the dental operatory for providing Conscious Sedation. Thus conscious sedation can be provided more effectively using this nasal hood specially with respect to pediatric patients. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the 2009 Society for the Advancement of Anaesthesia in Dentistry (SAAD) Annual Conference on sedation held at the Royal Society of Medicine in London, England on September 26. Former SAAD president Diana Terry opened the event while dentist Francis Collier discussed long sedation management. Another dentist Sheldon Collins gave an overview on the safety of midazolam. Doctors Joe Omar and André du Plessis offered tips on improving patient rapport.

The article describes the case of a 30-year-old female patient who showed unusual response to inhalation sedation titrated to an end point and reversed with 100% oxygen for 10 minutes in London, England. The preliminary assessment of the patient indicated dental anxiety. She became unresponsive after a topical anaesthetic was placed in the buccal sulcus around her upper right maxillary premoral teeth. The suspected differential diagnoses for the unusual response include a form of epilepsy or a type of mental health disorder.

Aim: To investigate trends in the provision of primary care dental general anaesthesia (DGA) and sedation following the new guidance from the General Dental Council.Design: Cross-sectional analysis of data about the provision of DGA in the General Dental Service and Community Dental Service from 1996/97 to 1998/99.Setting: The North West Health Region of England.Method: The numbers of DGAs in the General Dental Service (GDS) and Community Dental Service (CDS) for the three financial years, 1996/97, 1997/98 and 1998/99 were examined. In addition General Dental Service quarterly information about the numbers of general anaesthetics, sedations requiring another dentist or doctor, and claims for conscious sedation or inhalation sedation from April 1997 to December 1999 was requested from the Dental Practice Board.Results: The numbers of DGAs declined by 24 per cent between 1996/97 and 1998/99. Those in the GDS fell from 14,550 in the first quarter of 1997/98 to 3,527 in the first quarter of 1999/2000. The number of claims for sedation, which required another dentist or doctor, increased from 712 in the first quarter of 1997/98 to 2,989 in the same quarter of 1999/2000, while the number of claims for conscious sedation and inhalation sedation increased slightly from 2,847 to 2,963 over the same period.Conclusions: The revised General Dental Council guidance has reduced the numbers of DGAs being carried out in both GDS and CDS. The number of sedations involving another dentist or doctor has increased considerably but the new guidance seems to have had little effect on the numbers of patients receiving operated administered conscious sedation and inhalation sedation. [ABSTRACT FROM AUTHOR]

Background Conscious dental sedation is commissioned by NHS England for patients who are unable to accept dental treatment under local anaesthetic and behavioural techniques alone. Dental sedation provided by NHS England is carried out on a referral basis but this can be carried out in a primary or secondary care setting. This paper reports a study carried out to improve NHS dental services by supporting the work of multiple NHS England area teams in reviews of sedation services.Aim The aim of this paper is to identify variations in the provision of sedation services by NHS providers across England and explore possible factors affecting this variation.Method The project makes use of the recently developed NHS Business Services Authority (BSA) national public health data set, which Public Health England has developed in association with the BSA.Results Variations in population experience of sedation in England have been graphically demonstrated using a comprehensive BSA data set which captures all general dental service and public dental service (GDS/PDS) activity for a two-year period. There are wide and significant variations in population experience of sedation across England.Conclusion The variations in population experience of sedation across England are difficult to explain on purely clinical grounds.

Objective To investigate the use of flumazenil after midazolam-induced conscious sedation.Design and setting A prospective audit was carried out in the Department of Sedation and Special Care Dentistry at Guy's Hospital, King's College, London, 2009.Subjects Patients sedated with midazolam for dental treatment.Method All clinical staff completed the data capture proforma when flumazenil was administered to a patient after sedation with midazolam.Results Four hundred and fifty-three patients were sedated with midazolam. Flumazenil was used in 32 cases. No cases required flumazenil for the emergency treatment of respiratory depression.Conclusions The results of the audit confirmed the safe and appropriate use of midazolam for conscious sedation within the Department of Sedation and Special Care Dentistry at Guy's Hospital and demonstrated that flumazenil use was low and in accordance with current best practice. The audit has highlighted distinct indications for the post-operative use of flumazenil in specifically selected cases. Each case should be individually considered, justified and documented within the patient's clinical record. [ABSTRACT FROM AUTHOR]

The article offers information on the National Course in Conscious Sedation offered by the Society for the Advancement of Anaesthesia in Dentistry (SAAD) in England. The two-day course is conducted every March, June and November with dental practitioners and senior nurses as lecturers. The weekend course is held at Queen Mary, University of London's Bancroft Building. The second day of the course covers issues on allied practice, medico-legal and sedation services in primary care.

The article discusses the highlights of the 2007 annual conference of the Society for the Advancement of Anaesthesia in Dentistry (SAAD) that was held at the Royal Society of Medicine in England. Among the topics presented in the event include an overview of the report "Standards for Conscious Sedation in Dentistry: Alternative Techniques" and the political minefield of general practice. Several photographs from the event are provided.

Objective: This research explores the attitudes of medical professionals towards fasting patients prior to the use of conscious sedation., Materials and Methods: Questionnaires were completed by a total of 113 dentists, anaesthetists and dental nurses in order to identify current practices and opinions concerning the employment of pre-operative fasting in the context of conscious sedation in dentistry., Results: Seventy-eight (69%) respondents did not recommend fasting, compared with 35 (31%) who did. Those who did not recommend fasting were able to state significantly more adverse effects (P<0.01) of fasting when compared to the 35 (31%) who advocated fasting. Significantly more anaesthetists (80%) than dentists (14%) advised fasting patients (P<0.001). Thirty-two of 39 (82%) respondents mentioned the risk of aspiration to be the main reason for recommending that patients be fasted., Conclusion: Medical professionals in dentistry provide a wide range of conflicting views on the employment of fasting prior to conscious sedation reflecting the lack of homogeneity in literature surrounding this topic.

Objective To investigate the use of flumazenil after midazolam-induced conscious sedation.Design and setting A prospective audit was carried out in the Department of Sedation and Special Care Dentistry at Guy's Hospital, King's College, London, 2009.Subjects Patients sedated with midazolam for dental treatment.Method All clinical staff completed the data capture proforma when flumazenil was administered to a patient after sedation with midazolam.Results Four hundred and fifty-three patients were sedated with midazolam. Flumazenil was used in 32 cases. No cases required flumazenil for the emergency treatment of respiratory depression.Conclusions The results of the audit confirmed the safe and appropriate use of midazolam for conscious sedation within the Department of Sedation and Special Care Dentistry at Guy's Hospital and demonstrated that flumazenil use was low and in accordance with current best practice. The audit has highlighted distinct indications for the post-operative use of flumazenil in specifically selected cases. Each case should be individually considered, justified and documented within the patient's clinical record. [ABSTRACT FROM AUTHOR]

The article reports on the £1.2 million dental sedation unit which was opened at Newcastle Dental Hospital and School of Dental Sciences in England. The drug sedation unit has the capacity of treating 3,000 patients a year. It will provide hands-on training for undergraduates and postgraduates undergoing Newcastle University's diploma in conscious sedation.

The article focuses on the efforts of medical personnel at the Royal Bolton Hospital in England to improve their practice related to sedation for magnetic resonance imaging (MRI) scans. They found that most children between the ages of six months and five years can be safely and effectively sedated for MRI scanning with 50 milligram per kilogram (mg/kg) of chloral hydrate as a single agent. They encourage teams to use chloral hydrate as a primary agent for pediatric sedation.

The article reports on the launching of a new modern multi-disciplinary dental care facility, Oral Health Suite, primarily for children in Liverpool, England. The new facility constitutes three new surgeries with facilities for conscious sedation that is in particular suited to children. The facility is designed as an alternative to general anesthetic to relax young patients with dental anxiety and meliorate their response to treatment.

Introduction: A wide variety of procedures in all surgical departments are performed under conscious sedation with midazolam. Patients are required to adhere to a list of pre-operative instructions but poor compliance has been noted anecdotally in our department and in the literature. This can lead to delayed and cancelled appointments., Aim: We aimed to audit the compliance of patients in following preoperative sedation instructions in the oral and maxillofacial department of a large tertiary teaching hospital with a view to improving compliance. All patients undergoing conscious sedation for day case procedures in a five month period were audited. We implemented changes based on findings and a literature review, followed by a second eight month period of audit., Results: Twenty-nine and 30 patients participated in each cycle respectively. In the first cycle over 55% of patients were non-compliant. The most common reasons were not bringing a competent adult escort at the start of the appointment (17% of total) and having consumed alcohol in the 24 hours pre-operatively (17%). Based on this, the patient information leaflet was revised. Patients received copies when being listed and then with their posted appointment letter, as well as being verbally reminded before attending. Second cycle results revealed a 22% increase in compliance rates across all instructions with all patients bringing competent escorts along., Conclusions: Efficacy within the NHS is often achieved with simple and practical improvement to clinical and administrative practice. By achieving a reduction in non-compliance rates, the department was able to reduce appointment delays and waiting lists, ultimately to the patients' benefit.

Unlabelled: This paper reports on the findings of a quantitative, retrospective service evaluation. It compared a new, conscious, sedation-free technique to reduce anterior glenohumeral dislocations with the traditional methods of reduction (TMR) currently implemented., Objectives: The first objective for this study was to examine whether a new method, used at an Emergency Department (ED) in the south of England, of glenohumeral dislocation reduction, called the Oxford Chair Technique (OCT) can reduce anterior glenohumeral dislocations and to compare the success rates of reduction with the TMR. Secondary objectives examined how the OCT compared, using four set factors, against the TMR currently used. The fundamental comparisons being analysed was in terms of time taken for treatments., Methods: A retrospective service evaluation was performed using data collected from the Patient Administration System (PAS) software and the Picture Archiving and Communications System (PACS) on patients who presented to an ED in the South of England with an anterior glenohumeral dislocation between March 2005 and August 2006., Results: Of the 61 cases in which the OCT was used over the sampling period, 38 attempts to reduce the dislocation were successful, with 23 being unsuccessful. An overall success rate of 62% was obtained with the OCT. There were no complications reported with the OCT. Statistically significant differences were found with the mean time from arrival to discharge (OCT 141 v. TMR 254 min, p<0.001); mean time between the first diagnostic X-ray and post reduction X-ray (OCT 70 v. TMR 102 min, p<0.003) and the mean time between the post reduction X-ray and discharge (OCT 51 v. TMR 119 min, p<0.001). No patients treated with the OCT required conscious sedation compared to 90% of patients treated with TMR (p<0.001). Only 38% of patients treated with the OCT had morphine administered compared to 90% of patients treated with TMR (p<0.001)., Conclusions: Overall, the success rate for reduction using the OCT was good in view of this being a new treatment to the ED. While the OCT had a lower success rate of reduction compared to TMR, when reduction was successful using the OCT, there were overwhelming time-saving benefits to the patient with subsequent logistical benefits to the ED. The use of conscious sedation and morphine was also significantly less for the OCT group compared to TMR.

Objective: To describe primary care referral networks relating to children's dental care and the main influences on referral decisions taken by dentists working in a primary care setting., Design: A postal questionnaire to all 130 general dental practitioners (GDPs) in contract with Primary Care Trusts (PCTs), and 24 Community Dental Service (CDS) dentists in Liverpool., Outcome Measures: Characteristics of patient groups and factors influencing the choice of referral pathway of children referred from primary dental care., Results: There were good responses rates (110 [85%] GDPs and 22 [92%] CDS dentists). The two main reasons why GDPs referred children to hospitals were (a) for treatment under general anaesthetic (GA) or relative analgesia (RA) and (b) for restorative care of dentally anxious children. GDPs also referred anxious children requiring simple restorative care and/or RA to the CDS. Only eight GDPs (7%) cited a lack of experience as a reason for referral of dentally anxious children for simple restorative care, compared to 53 (48%) who cited a lack of RA facilities, and 25 (23%) who cited financial considerations., Conclusions: GDPs refer children to both hospital services and the CDS, and identify a lack of RA facilities and economic pressures as key reasons for referral.

Aim: The aim of this study was to evaluate the self-perceived educational needs of a randomly selected group of general dental practitioners (GDPs) in the Merseyside region (UK)., Materials and Methods: Eighty-seven GDPs were randomly selected from 850 in the region and asked to complete a self-evaluation questionnaire regarding their self-perceived educational needs., Results: Seventy-five (86%) responded, of which 52 (69.3%) were male and 23 (30.7%) female. There was no significant difference in self-perceived knowledge in any of the dental disciplines when gender and period of time since qualification were used as predictor variables. The majority of the GDPs felt they had a good knowledge of restorative dentistry and dental radiography. Some of the GDPs felt they had poor knowledge in implant dentistry, oral medicine, orthodontics, dental sedation techniques, oral surgery, endodontics, periodontics and dental radiography. None of the respondents felt they had poor knowledge in restorative dentistry, prosthodontics and paediatric dentistry. Seventy-four (98.7%) of the responding GDPs were motivated to attend continuing professional development (CPD) courses because of an interest in a particular dental discipline and only one reported attending out of personal learning needs. Implant dentistry was indicated by 30 (40.0%) of the respondents as their training programme of choice., Conclusions: The respondents had high self-perceived knowledge of restorative dentistry, dental radiography, periodontics, endodontics, paediatric dentistry and prosthodontics. The respondents had low self-perceived knowledge of implant dentistry, orthodontics, oral medicine and dental sedation techniques. Of GDPs surveyed, 98.7% applied for courses they liked to attend, rather than needed to attend. Fifty-two per cent of male GDPs surveyed expressed a desire for training in implant dentistry.

Aims and Objectives: The use of sedation in the management of pain and anxiety for the provision of dental care is as vital to the dental profession as are windscreen wipers to a motor vehicle. Not for use on every patient or every occasion, but in times of need to wipe away the tears, and essential for effective work. Training in sedation techniques should be a part of the undergraduate curriculum, and postgraduate opportunities need to be developed to support this important aspect of care. This paper examines a particular training course provided within the Department of Sedation and Special Care Dentistry at GKT Dental Institute, King's College London, leading to the Diploma in Conscious Sedation for Dentistry (Dip.D.Sed). The aim of this study was to investigate what impact the course has had on the practice of sedation. Three objectives were defined: 1) Students' evaluation of the course; 2) Students' practice in sedation prior to and on completion of the course; 3) Students' involvement in sedation training of dentists or dental nurses following completion of the course., Method: Information was obtained by postal questionnaire from students who had attended the course since its inception in 1997 to 2000., Results: 30 students completed and returned the questionnaire which represented a 100% response. There was an overall expression of satisfaction from students on the course content and the experience they had obtained. The range of experience was 70-100 treatment episodes over 40 clinical sessions. An increase in both the practice of sedation and the involvement in training (dental nurses and dentists) was also shown. The greatest clinical change was the increase in use of intravenous sedation by the students from the community dental service., Conclusion and Recommendation: This study concluded that the objectives of the course had been achieved. The importance of providing training that enables the safe and effective provision of sedation within primary care as an operator sedationist was strengthened by this study. The value of an intermediate level between the two day section 63 course and the six month diploma course was suggested by students in this study. The development of a clinical attachment based on The Standard Course in Conscious Sedation was proposed as a possible option to fill the gap. The provision of postgraduate training in sedation is limited particularly in some areas of the UK. This problem should be addressed by increasing the opportunity for postgraduate training in sedation by dental schools and postgraduate deaneries. Work towards increasing the funding and opportunities for training in this important area of care needs to be undertaken.

Objective: To develop a set of guidelines for referral of children for simple extractions under general anaesthesia and to determine if services providing general anaesthetic extractions comply with the guidelines., Design: The guidelines were developed with reference to published literature and experts in the field. Patient's records were used to determine the compliance with the guidelines., Setting: Community dental services in the North West of England in 2000., Subjects: One hundred and ninety six sets of patient records of children attending to have teeth extracted under general anaesthesia were studied., Results: The mean age of the 196 children was 6.8 years (SD = 2.5 years) and ranged from 2.7 to 15.8 years. Caries was the prime reason for extractions (182; 93b). Of the 196 children who received a general anaesthetic, 103 (53%) dentists had complied with the general anaesthetic referral guidelines whilst 93 (47%) had not. There was wide variation in compliance across 11 trusts in the North West of England. The lowest compliance was 25% and the highest 93%., Conclusion: This study has demonstrated that there can be considerable agreement amongst a group of experts on what constitutes clear justification for extracting teeth under general anaesthesia. However there can be marked variation in compliance with these guidelines.

A prospective audit of upper gastrointestinal endoscopy in 36 hospitals across two regions provided data from 14,149 gastroscopies of which 1113 procedures were therapeutic and 13,036 were diagnostic. Most patients received gastroscopy under intravenous sedation; midazolam was the preferred agent in the North West and diazepam was preferred in East Anglia. Mean doses of each agent used were 5.7 mg and 13.8 mg respectively, although there was a wide distribution of doses reported. Only half of the patients endoscoped had some form of intravenous access in situ and few were supplied with supplementary oxygen. The death rate from this study for diagnostic endoscopy was 1 in 2000 and the morbidity rate was 1 in 200; cardiorespiratory complications were the most prominent in this group and there was a strong relation between the lack of monitoring and use of high dose benzodiazepines and the occurrence of adverse outcomes. In particular there was a link between the use of local anaesthetic sprays and the development of pneumonia after gastroscopy (p < 0.001). Twenty perforations occurred out of a total of 774 dilatations of which eight patients died (death rate 1 in 100). A number of units were found to have staffing problems, to be lacking in basic facilities, and to have poor or virtually non-existent recovery areas. In addition, a number of junior endoscopists were performing endoscopy unsupervised and with minimal training.