Kilborn A, Suresh N, Averley P
Queensway Dental Practice & Anxiety Management Clinic, 170 Queensway, Billingham, Teesside.
SAAD Dig. 2009 Jan;25:15-21.
The aim of this prospective pragmatic audit was to investigate the level of consciousness experienced by children requiring conscious sedation in a primary care sedation service, using an 'alternative technique' to avoid referral to hospital for general anaesthesia. This technique was only applied to children who were unable to accept treatment with the use of standard inhalation sedation. The technique involved titrated inhaled oxygen and nitrous oxide and titrated sevoflurane with intravenous fentanyl and titrated midazolam. The described technique was provided by an experienced team with appropriate facilities that complied with contemporary standards and guidance. During treatment and recovery the consciousness level of children was recorded using a modified Wilson's scale. Of the sample of 573 children who received the audited technique, 1.9% (11 children) scored level 5 on the modified Wilson scale (eyes closed but responsive to mild physical stimulus). Due to the fine control this technique offers, the duration of this level of consciousness was for mostly less than a minute and no more than five minutes. No children became unresponsive. The results of this audit demonstrate that the technique meets current standards and guidelines for 'alternative' conscious sedation, with a wide margin of safety and the rendering of loss of consciousness unlikely. 99% of patients who would otherwise have required general anaesthetic for dental treatment successfully completed their treatment using this technique.
这项前瞻性实用审计的目的是，在初级保健镇静服务中，对需要清醒镇静的儿童所经历的意识水平进行调查，采用一种“替代技术”以避免转诊至医院进行全身麻醉。该技术仅应用于无法接受标准吸入镇静治疗的儿童。该技术包括滴定吸入氧气和一氧化二氮，滴定七氟醚并静脉注射芬太尼，以及滴定咪达唑仑。所描述的技术由一个经验丰富的团队提供，具备符合当代标准和指南的适当设施。在治疗和恢复过程中，使用改良的威尔逊量表记录儿童的意识水平。在接受审计技术的573名儿童样本中，1.9%（11名儿童）在改良威尔逊量表上得分为5级（眼睛闭合但对轻微身体刺激有反应）。由于该技术提供了精细控制，这种意识水平的持续时间大多不到一分钟，且不超过五分钟。没有儿童失去反应能力。本次审计结果表明，该技术符合“替代”清醒镇静的现行标准和指南，具有广泛的安全边际，且不太可能导致意识丧失。99%原本需要接受牙科治疗全身麻醉的患者使用该技术成功完成了治疗。
