Conscious sedation guidance

Abstract

This guidance is intended to promote good clinical practice for the provision in dentistry of conscious sedation that is both safe and effective. It is not a recipe book for sedation and therefore does not include details of drug dosages. The recommendations are applicable to all patients receiving conscious sedation, to facilitate the provision of any type of dental treatment whether it is delivered in a dental practice, a community dental service clinic or a hospital setting. It also covers the provision of conscious sedation for dental treatment provided on a domiciliary basis. Specifically excluded from this guidance, however, are patients who require assisted ventilation, intensive care sedation, premedication for general anaesthesia, postoperative analgesia, sedation in palliative care, night sedation and sedation in the home setting other than for the provision of dental treatment on a domiciliary basis. Existing guidelines, relevant systematic reviews, policy documents, legislation or other recommendations were reviewed and appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. To supplement this information, key questions were formulated by the Guidance Development Group and used as the basis for designing systematic literature search strategies to identify further research evidence that may address these questions, including unpublished work where relevant. The following internet sites were searched for guidelines: New Zealand Guidelines Group, Canadian Collaboration on Clinical Practice Guidelines in Dentistry, National Guidelines Clearinghouse, FDI World Dental Federation, National Electronic Library for Health Guideline Finder, and Medline. The Cochrane Library was searched for systematic reviews and Medline, Embase and the Cochrane Library for studies to address key questions. The searches were supplemented by material already known to members of the Guidance Development Group. Titles and abstracts of the identified references were screened for relevance independently by two researchers who were not members of the Guidance Development Group. Disagreement about the inclusion of specific individual references for further consideration was resolved by discussion and if necessary the opinion of a third researcher was sought. Included references were appraised and data was abstracted independently by two researchers using a specifically designed data-abstraction form. This information was then checked for inconsistencies, which were resolved by discussion, and used to construct evidence tables. The evidence tables were presented to the Guidance Development Group to inform their decision-making and their recommendations related to the key question under consideration. Levels of evidence were assigned by two researchers who were not members of the Guidance Development Group. Formulation of each recommendation was achieved by consensus reached through discussion, drawing on the broad range of interest and experience of sedation related to dentistry within the membership of the Guidance Development Group. Consultation and peer review were conducted prior to publication. A draft of the guidance was the subject of discussion at the Dental Sedation Teachers Group annual symposium in April 2004. Subsequently, approximately 100 copies were distributed throughout the UK to a range of professional organisations and individuals who have an interest in dental sedation, and comments were requested. In addition, all dentists in Scotland who recently claimed the National Health Service allowance for treatment with sedation were invited to comment. The consultation draft was also made available on the group's website ( www.scottishdental.org/cep ). All comments received through this consultation were considered and the guidance was amended accordingly prior to peer review. Further amendments were made in response to feedback from peer reviewers before publication. The guidance will be reviewed in 2 years' time (2008) and if there have been significant changes it will be updated accordingly. The detailed guidance make 48 recommendations in a range of areas: A number of recommendations were made regarding the future conduct and reporting of clinical trials. The following areas were highlighted as requiring further high-quality research: The complete guidance is available for download at www.scottishdental.org/cep/guidance/dentalsedation.htm .