Intravenous Conscious Sedation Research Articles

(167) Penile Plication is Well Tolerated Under Conscious Sedation: A Prospective Comparison of Deep Intravenous Vs. Nursing Administered Conscious Sedation

Abstract Introduction Penile plication is a common and effective surgical treatment for Peyronie's Disease. Although generally performed under general or spinal anesthesia, patient tolerability of penile plication under conscious sedation (CS) has several advantages: reduced anesthetic risk, health care cost savings, decrease wait times, and the ability conduct in outpatient facilities. While CS would provide significant potential benefit, there have been no evaluations of patient-reported tolerability to penile plication completed under conscious sedation nor comparisons with varying administrations. Objective To evaluate and compare patient-reported tolerability of penile plication performed under two CS sedation approaches: (1) deep intravenous conscious sedation (IVCS) administered by anesthesiologists and (2) nursing administered conscious sedation (NACS). Methods We evaluated procedure tolerability in a prospective cohort of 40 adult patients (23 IVCS; 17 NACS) undergoing primary penile plication between August 2022 and May 2023. Revision surgeries, and those with hourglass or hinge deformities were excluded. IVCS patients were administered midazolam (5mg) and ketamine (20mg) along with a continuous infusion of propofol (25-50 mcg/kg/min) and remifentanil (0.05 mcg/kg/min). NACS sedation protocol consisted of midazolam (1-2 mg) and fentanyl (50-100 ug). Patient baseline characteristics, procedure information, pain assessments (Likert scale; 0 [no pain]-10[most pain]) made by the patient and surgeon before during and after the procedure were collected. Following a post-surgical healing period, patients were contacted and administered an evaluated standardized patient tolerability questionnaire. Overall patient tolerability, pain assessments, and complication rates were compared descriptively, and using Wilcoxon sign-rank tests and McNemar tests. Results Baseline characteristics were similar between IVSC and NACS groups. Median pre-operative curvature of the IVCS cohort was 55 degrees (IQR=43.75-76.25) whereas the NACS curvature was 45 degrees (IQR=45-60). There was a 100% procedural success rate with no intra-operative concerns leading to the abortion of the procedure or conversion to general anesthetic. At six-week post-operative follow up, all patients had functional curvature. 100% of patients in the IVCS and NACS cohorts reported that they would recommend CS to others. Additionally, 95% (19/20; CI95=75.3%-99.0%) of those undergoing IVCS and 93.3% (14/15; CI95=70.2-98.8%) of the NACS cohort would choose CS over general anesthetic if they had to undergo the same surgery again. Sedation choice did not differ between CS groups (p=1.0). Most patients reported no pain pre-operatively (IVCS:[18/20]; NACS:[13/15]; p=1.0), peri-operatively (IVCS:[16/20]; NACS:[13/15]; p=0.68), or immediately post-operatively (IVCS:[14/20]; NACS:[14/15]; p=0.20). Two-hour post-operative pain did not differ between groups (p=0.89). Median two-hour post-operative IVCS pain was 2.5 (IQR=0-5.0) whereas median NACS pain was 3.0 (IQR=1.5-3.0). Conclusions Penile plication is exceptionally well tolerated when completed under either anesthesiologist administered intravenous conscious sedation or nursing administered conscious sedation. Most patients would choose conscious sedation over general anesthetic for the procedure in the future and all would recommend conscious sedation to others. Self-reported pain did not differ between groups and most patients reported no pain pre-, peri-, or immediately post-operatively. These results suggest that penile plication surgery can be completed in an outpatient setting under conscious sedation administered by trained nursing staff, which is expected to decrease costs, risks and wait-times of the procedure. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Clinical Analysis of 32 Cases of Subglottic Benign Airway Stenosis Treated With Montgomery T Silicone Stent.

Objective: To explore the complications of long-term placement of Montgomery T silicone stent (T-tube) in the treatment of subglottic benign airway stenosis (SBAS) and the timing of successful T-tube removal. Methods: We retrospectively collected the clinical data of 32 patients with SBAS who underwent the treatment of T-tube and analyzed their placement and successful removal of the T-tube. Results: There were 22 males and 10 females, aged from 21 to 79 years (60.9 ± 13.7 years). The T-tubes were successfully placed in all 32 patients, and 6 patients (18.8%) with mild stenosis were placed by the intravenous conscious sedation. The longest follow-up period was 60.4 months, and 17 patients (53.1%) had the T-tubes for more than 12 months; 5 patients (15.6%) were changed to the tracheostomy cannula after unplanned removal of the T-tubes for various reasons; the T-tubes were successfully removed in 9 patients (28.1%), and the duration of T-tubes placement was 5.2-22.7 months (12.1 ± 6.3 months), among them anatomical stenosis in 9 patients (100%). Secretion retention was observed in 32 patients (100%), granulation tissue hyperplasia was observed in 9 patients (28.1%), and the normal ventilation was not affected in most patients by bronchoscopic treatment and follow-up; the T-tubes were removed in 3 patients due to severe complications. There was no significant difference in the incidences of secretion retention and granulation tissue hyperplasia between the time point at 1 week, 1 month, 3 months, and 12 months, p > 0.05. In patients with T-tube more than 12 months, the severity of secretion retention at 1 week, 1 month, 3 months, and 12 months was significantly different, p < 0.05, however, there was no significant difference in the severity of granulation tissue hyperplasia, p > 0.05. Conclusions: T-tube is safe and effective in the treatment of SBAS. The severity of secretion retention increased in patients with long-term placement of the T-tube. For patients with mild stenosis and anatomical stenosis, the T-tube removal can be attempted at about 1 year of follow-up.

Evaluating Patient Tolerability for Urological Procedures Under Conscious Sedation: A Prospective Study

PurposeAdministration of general or spinal anesthesia is associated with anesthetic-related complications, long wait times and high costs. Using intravenous conscious sedation and/or local anesthesia is an emerging alternative for a myriad of urologic procedures. Our objective was to prospectively evaluate patient-reported and surgical outcomes of urologic procedures with conscious sedation with or without local anesthesia. MethodsPatients were enrolled from June to Aug 2021 at a tertiary care hospital. All procedures were completed using fentanyl, midazolam or both with patient and procedural data recorded upon completion. Patients were telephoned 4-6 weeks post-procedure with a standardized patient tolerability questionnaire. A multivariable adjusted logistic regression analysis was performed to evaluate whether a patient would opt for conscious sedation again as opposed to general anesthesia. ResultsA total of 196 procedures were performed by 6 attending urologists with an overall success rate of 98.5% and 0% intraoperative complication rate. At 4-6 weeks follow-up, 85.6% of patients reported they would opt for conscious sedation as opposed to general anesthesia. Predictors of opting for conscious sedation in the future was older age (OR: 1.049; p = 0.017) and surgeon perceived level of patient tolerability (OR: 2.124; p < 0.001, scored 1-10). ConclusionPhysician directed, nursing administered IV conscious sedation is a viable alternative for various urologic procedures and has minimal risk of perioperative complications.

Establishment of an intravenous conscious sedation service at a University Dental Clinic in Tanzania.

With advances in safety measures for anesthesia, conscious sedation has gained popularity in the field of dentistry and has become essential in dental practice worldwide. However, in Tanzania, intravenous (IV) sedation is rarely practiced in the dental field. Therefore, we report the establishment of sustainable IV conscious sedation in dental practices and subsequently train local OMS residents in Tanzania. In 2019, intravenous conscious sedation was initiated at the University Dental Clinic of the Muhimbili University of Health and Allied Science (MUHAS), Tanzania. During the preparatory phase of the program, local oral and maxillofacial surgeons (OMSs) were given a series of lecture notes that concentrated on different aspects of IV conscious sedation in dentistry. During the on-site training phase, an oral surgeon from the United States joined the OMSs for case selection, IV-conscious sedation procedures, and patient follow-up. Patients were recruited from existing patient records at the MUHAS Dental Clinic. The first conscious IV sedation program in dentistry was successfully launched at the University Dental Clinic in Tanzania. The local team of OMSs was trained on the safe administration of sedative agents (midazolam or ketamine) to perform various minor surgical procedures in a dental office. Nine patients with different ages, body masses, and medical conditions benefited from the training. No complications were associated with IV conscious sedation in the dental office. This was the first successful "hands-on" training on IV conscious sedation provided to OMSs in Tanzania. It laid the foundation for the sustainable care of patients with special needs requiring oral health-related care in the country.

Protocolized nurse-guided intravenous conscious sedation for cryoballoon ablation of paroxysmal and persistent atrial fibrillation

Abstract Background Nursing staff is playing an increasingly important role in arrhythmia units and it entails acquiring more specialized knowledge. Intravenous conscious sedation is being administered more frequently in a wide variety of cardiac procedures including cryoballoon ablation (CBA). Nurses and physicians have distinct yet collaborative roles in the management and care of the patient receiving conscious sedation. It is imperative that the nurse be aware of her/his role in caring for the patient before, during, and after the administration of intravenous conscious sedation. Purpose We aimed to evaluate the nurse's role, working in coordination with the medical staff, in intravenous conscious sedation for CBA following a standardized protocol ensuring proper handling and administration of the different drugs, monitorization of vital signs and management of drug infusion in order to avoid pain but also complications inherent to the procedure and sedation. Method We included consecutive patients with paroxysmal or persistent AF who underwent a CBA from 2017 to 2021. We evaluated a nurse-guided sedation, under medical surveillance, in CBA procedures using propofol. The dosage was based on the patient's weight, starting sedation with a bolus of 1 ml (1% solution) for every 20 kg of weight, and starting a perfusion at 10 ml/h (2% solution), monitoring constantly patient's vital signs, especially blood pressure and O2saturation. This infusion was adjusted according to the patient's response. During the procedure, on a stable hemodynamic situation, booster bolus of 1 ml (1% solution) could be administered approximately every 15 minutes when needed for sedation. When systolic blood pressure was under 100 mmHg, a solution of midazolam (1mg/ml) and fentanyl (0.05mg/ml) in a mixture of 1cc + 1cc was preferred as booster. Saline and colloid solutions andephedrine (30mg/ml) bolus could be used when severe hypotension to revert propofol's hypotensive effect. Systematic standardized CBA was performed and intraprocedural and periprocedural complications were recorded. Results 104 patients were included (mean age 58±8 year-old, 85% male). Of these patients, 76 (73%) had recurrent paroxysmal AF, failure of antiarrhythmic drugs was present in 96% and prior radiofrequency ablation in 4%, 61 (59%) showed left atria enlargement (&amp;gt;40 mm or area &amp;gt;20 cm2), and 11 (10%) had structural heart disease. Mean CHA2DS2VASc score was 1. Baseline characteristics in Table 1. Procedural-related complications occurred in 6 patients (5%), transient phrenic nerve palsy in 2 patients and vascular damage in 4. All sedations were performed without complications. Conclusions In our experience, protocolized nurse-guided intravenous conscious sedation under medical surveillance in CBA procedures is safe and really useful. It contributes to help medical operators to focus on the procedure sharing the patient's sedation management with trained nurses. Funding Acknowledgement Type of funding sources: None.

Factors Associated with Variability in Pulse Wave Transit Time Using Pulse Oximetry: A Retrospective Study.

Pulse wave transit time (PWTT) is the time difference between the occurrence of an R-wave on an electrocardiogram and the detection of pulsatile signals on a pulse oximeter, which reflects changes in blood pressure (BP) corresponding to the vessel wall compliance. However, the factors affecting PWTT variability have not been determined. Thus, we investigated the BP changes associated with variations in PWTT and identified the clinical characteristics associated with these variations. Data related to 605 cases of dental procedures performed under intravenous conscious sedation from April 2020 to November 2021 were collected, and 485 cases were enrolled. Heart rate, systolic blood pressure before and after local anesthesia (LA) administration, and crest and trough PWTT waves during LA administration were recorded. Thereafter, PWTT variability was calculated; cases were divided into two groups: large PWTT variability (LPV, n = 357) and small PWTT variability (SPV, n = 128). The index of large PWTT variability could not detect changes in BP. Logistic regression analysis revealed that factors, such as LA use, age, hypertension, and dental treatment phobia were associated with PWTT variability. The use of epinephrine more than 36.25 µg in each LA resulted in PWTT variability of more than 15 ms.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Dental sedation—Airing a concept

AbstractAimTo establish current practices and experiences of dental practitioners, who are carrying out procedures under sedation in primary care, relating to assessment and management of the airway. We also review current recommendations and consider a need for further clinical guidance to standardise practice.MaterialsThe survey was created using Survey Monkey and distributed through social media channels such as WhatsApp, Facebook and via emailing a local sedation group.MethodsA service evaluation was carried out in the form of an online survey. This was distributed via social media and by emailing previous and current attendees of Dental Sedation Courses. This link remained active for 3 months with a minimum target of 50 completed responses. During this period, a total of 64 responses were received.Results51 of 64 respondents stated they complete airway assessments, of which, less than half used a pro‐forma for this purpose. Within this cohort, 21.9% of respondents acknowledged a compromised airway incident requiring initial management, with the most favoured adjunct/manoeuvre being a head tilt chin lift of the patient.ConclusionAs sedation operators, dentists carry the responsibility for the provision of dental treatment alongside the management of the airway. Conscious intravenous sedation is usually carried out using midazolam, a short acting and amnesic benzodiazepine. Whilst this is widely used, risks such as respiratory depression or loss of the airway remain. To prevent this, it is vital for an airway assessment to be carried out pre‐operatively as echoed by the Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) and Scottish Dental Clinical Effectiveness Programme (SDCEP). This article highlights the need for guidance to support general dental practitioners in the pre‐operative assessment of airways to further streamline and improve patient care.

134 Extending the limits of vaginal hysterectomy under local anesthesia and conscious sedation

Introduction and aim of the video: In this video we present the surgical management of a 58-year-old woman presenting with a large prolapsed myomatous uterus treated with vaginal hysterectomy (VH) and pelvic floor repair (PFR) (uterosacral ligament suspension and posterior colporraphy) under local anesthesia and conscious sedation. Method: The patient underwent VH and PFR by using an infiltration of a local anesthetic solution of lidocaine, ropivacaine and adrenaline in combination with intravenous (iv) conscious sedation.

The Physiological Basis Of The Oral Surgical Management Of A Patient With Polycythemia Rubra Vera: A Pathway For The Development Of A Protocol

Various oral surgical procedures are currently performed under local anaesthesia and conscious sedation as a day surgery procedure. Both oral and intravenous conscious sedation are available as a choice. Oral sedation with Alprazolam and Codeine is very effective for most oral surgical procedures especially the removal of impacted third molars and surgical placement of implants. It is this sedation regimen that comprises the synergistic use of both aprazolam and codeine to effect sedation with amnesia that is the standard procedure at the Faculty of Dentistry of the International Postgraduate Medical College. The purpose of this case report is to appraise the possible negative effect of Alprazolam and Codeine sedation mentioned above on a patient who presented with polycythaemia rubra vera (a very rare haematological condition). This is because the codeine component of this combination will depress the respiratory centre in the medulla oblongata putting the patient at risk. The case study is that of a 70-Year-old male patient who had been a regular patient for approximately 10 years ago at the Faculty of Dentistry, International Postgraduate Medical College (IPMC), where a total upper denture and a partial lower denture were placed. The patient returned in 2019 with the chief complaint of halitosis and pain in the mandibular posterior right region. The patient gave past medical history of PRV, epilepsy and hypertension and history of being on multiple medications for these conditions. The treatment plan advised was total extraction of the remaining mandibular dentition and excisional biopsy of the suspicious lesion mesial to the mandibular right first molar, together with a complete lower denture replacement. The procedure was done without sedation and at no time was the patient considered to be in danger as it relates to oxygen saturation, carbon dioxide drive to the brain and bleeding. Every hematologist managing patients with PRV will be very concerned as to how these patients are managed by dentists, particularly as it relates to oxygen saturation, carbon dioxide drive to the brain and hemostasis. Similarly, most dental practitioners that are managing such patients may not be familiar with the technicalities surrounding the clinical and operative management of these patients. It is for this reason that this case report focusing on oral surgical management of a patient with PRV is of significance to the dental literature, particularly as it aims to develop a working group for the development of the protocol for the management of PRV.

Airway Assessment for Intravenous Sedation in Dentistry

The ability to manage an airway is an essential skill for the safe provision of intravenous conscious sedation. A systematic airway assessment will allow identification of risk factors pre-operatively, flagging potential airway problems and aiding case selection. If difficulties arise, the practitioner will be able to act efficiently having anticipated the risk factors. Importantly, cases unsuitable for primary care can be readily identified and referred appropriately. In the interest of patient safety, this article aims to present methods of airway assessment that can be incorporated into the pre-sedation assessment. CPD/Clinical Relevance: This article discusses airway assessment methods relevant to intravenous conscious sedation to promote patient safety.

Comparison of variants of anesthesia for left atrial appendage occlusion in patients with atrial fbrillation

Objective: comparison of general anesthesia (GA) and intravenous conscious sedation during left atrial appendage occlusion (LAAO).Materials and Methods. The study included 120 patients from LAAO Register at the National Medical Research Center of Cardiology, who were divided into GA (n = 100) and intravenous sedation (n = 20) groups. In-hospital outcomes were assessed, as well as outcomes and data of transesophageal echocardiography (TEE) at 45 days and 6 months.Results. 3 patients required intraoperative conversion of the anesthetic method to GA. The duration of the procedure, the time of fluoroscopy, the amount of contrast medium, and the technical success did not differ signifcantly between the two groups. The incidence of in-hospital complications in the GA group was 10%, and 15% in the intravenous sedation group (p = 0.453). There were no statistically signifcant differences between the groups in long-term outcomes and TEE data after 45 days and 6 months.Conclusion. Combined intravenous sedation with local anesthesia is an effective and fairly safe method of anesthesiological support for implantation of the occluder of the left atrial auricle. It can be used in patients with a high risk of GA, with predictable difculties of tracheal intubation, as well as if the patient wishes accordingly. The limitations of the use of intravenous sedation in combination with local anesthesia are anatomical variants of SFM that are difcult for occluder implantation, as well as the patient's low tolerance to ECG in consciousness.

A patient information video for treatment under intravenous conscious sedation: considerations, challenges and prospects

This article describes the use of a newly developed animation for the delivery of patient information pertinent to dental treatment performed under intravenous conscious sedation, and provides an understanding of how digital health-related information impacts upon the patient experience. This article provides insight into the rationale for using animation as a means to deliver healthcare-related information, the process undertaken to develop this animation and how the themes and imagery in the animation can be used more broadly to further enhance the patient experience in primary and secondary dental care settings. CPD/Clinical Relevance: This article outlines the process of developing an animation for patient information and the impact animation can have upon patient experience locally as an aid to delivering instructions.

Dental disadvantage for people with disability: a potential solution for a problematic area of care

This paper considers the oral health of people with disability and the disadvantage they experience compared to those who do not have a disability. There are many influencing factors for this including service provision and appropriate training for staff. A potential solution is proposed demonstrating that even advanced dental care is possible for people with complex disability. This meets the principal of equitable care for people with disability. The example concerns the provision of a lower anterior bridge for a gentleman with mid to end stage Huntington’s disease and significant uncontrolled choreic movements. Intravenous conscious sedation is used to facilitate complex treatment and to demonstrate a clinical skill which can open doors for the treatment of adults with disability

Extending the limits of vaginal hysterectomy under local anesthesia and conscious sedation

In this video we present the surgical management of a 58-year-old woman presenting with a large prolapsed myomatous uterus treated with vaginal hysterectomy (VH) and pelvic floor repair (PFR) (uterosacral ligament suspension and posterior colporraphy) under local anesthesia and conscious sedation. The patient underwent VH and PFR by using an infiltration of a local anesthetic solution of lidocaine, ropivacaine and adrenaline in combination with intravenous (iv) conscious sedation. Debulking techniques, such as intramyometrial coring, uterine bisection, myomectomy and wedge resection, were used to facilitate VH. The final weight of the removed uterus was 870g. This video demonstrates that performing a surgically challenging VH under local anesthesia is feasible. Vaginal uterine morcellation can be performed to debulk the enlarged uterus so that hysterectomy can be accomplished under local anesthesia. The use of local anesthesia may safely be offered as an alternative to patients undergoing a complex vaginal hysterectomy and reconstructive surgery.

Midazolam dosage in intravenous conscious sedation

AbstractAimMidazolam is the first‐line drug for intravenous conscious sedation in dentistry. A 5‐mL ampoule of midazolam (1 mg/mL) is a widely used preparation for a carefully titrated optimum sedation dose tailored to the individual patient. In past times at Liverpool University Dental Hospital, a 10‐mL pre‐filled syringe of midazolam (1 mg/mL) was used and with the transition to 5‐mL ampoules, a study was undertaken to assess whether this change had an impact on dosages delivered by sedationists.Materials and methodsA retrospective study was carried out to include 100 patients who were sedated on the Oral Surgery department for a range of surgical procedures. A total of 50 patients were sedated using a 10‐mL pre‐filled syringe and 50 patients were sedated using 5‐mL ampoules. Data collection looked at the total midazolam dosage and other factors including operator, procedure complexity, ASA grade, sedation score and operating conditions score.ResultsThere was a statistical difference between the mean dosages for both groups with an overall lower dose administered in patients who were sedated with 5‐mL ampoules.ConclusionsThe study suggested an impact of human factors when behavioural changes occur as a result of change in practice. The outcome of the study suggested revision of the factors which should influence midazolam dosage and are discussed in this study.

&gt;Management of Avulsion Injury of the Nose Due to a Human Bite Under Local Anesthesia with Intravenous Conscious Sedation: A Case Report

&gt;Management of Avulsion Injury of the Nose Due to a Human Bite Under Local Anesthesia with Intravenous Conscious Sedation: A Case Report

Safety and Efficacy of CT Fluoroscopy in Celiac Plexus Neurolysis in Hepatocellular Carcinoma Related Abdominal Pain

Abstract Background: Management of hepatocellular carcinoma related abdominal pain is a complex and challenging issue as most HCC develop on top of liver cirrhosis and the deficient hepatic function obstacle the high-dose narcotic analgesics. Imaging-guided Celiac plexus neurolysis for refractory pain management has been used for almost 100 years in patients with advanced abdominal malignancy and effectively control pain without the noted side effects typical of opioids, however CT guided celiac block is the most accurate method for celiac block guidance the lack of real time visualization, radiation exposure & time consuming call the need for real time CT fluoroscopy guidance. Aim of Study: To assess the efficacy of CT fluoroscopy in celiac plexus neurolysis in hepatocellular carcinoma related abdominal pain. Patient and Methods: This study was carried out on 30 adult patients suffering from abdominal pain due to infiltrative or metastatic HCC and pain not controlled by WHO analgesic step ladder. Celiac Plexus Neurolysis (CPN) is achieved with intravenous conscious sedation, prognostic block accomplished by using injecting a near by anesthetic accompanied with the aid of alcohol for celiac plexus block, after 10 minutes, if the injection correctly relieved pain; maximum filling of the retro-pancreatic area with ethanol is a sign of enough neurolysis. Results: Marked decrease of pain severity in all patients was noted as a sharp fall of the Numerical Rating Scale (NRS) score on the 1 st day post CPN with relatively stationary course for 3 months in the patient survived their primary disease. Conclusion: Celiac Plexus Neurolysis (CPN) provides an effective technique in decreasing pain severity in HCC patients, and so decreases the analgesic requirement, their side effects and may increase patients' survival, CT fluoroscopy guided CPN is an easy and safe procedure that provides high success rates, markedly decreased patient radiation dose and total procedure time compared with use of conventional CT guid-ance.

The Establishment of an Intravenous Conscious Sedation Service for Adult Patients in a Primary Dental Care Setting

Dental anxiety is common within the population and can detrimentally affect the delivery of dental care for those patients affected. Non-pharmacological-based behaviour management techniques are available to the clinician but may not be sufficient or applicable for every patient. In such cases, intravenous conscious sedation with midazolam has been demonstrated to be safe, effective and well tolerated. The present article reviews the criteria and guidance which must be addressed by the dental team when establishing an intravenous conscious sedation service in a primary dental care setting. CPD/Clinical Relevance: General dental practitioners may wish to consider establishing a conscious sedation service in their practices to facilitate the care of nervous patients or those undergoing prolonged, unpleasant treatments such as surgical procedures. The present paper aims to highlight the considerations which require to be addressed in order to establish such a service for adult patients using intravenous midazolam.

Clinical practices and education of intravenous moderate/deep sedation in Japan

Safety and comfort during dental procedures are the key factors for high quality dentistry and fundamentals for patient satisfaction. Systemic managements such as general anesthesia and moderate/deep sedation are widely applied to dental outpatients for safe and comfortable dentistry by dentists in Japan. For intravenous moderate sedation, midazolam, propofol and their combination are common choices for dental outpatients. Sometimes deep sedation is required especially in patients with intellectually disability, severe fear/anxiety or severe gaging reflex. Some of these patients may undergo general anesthesia instead of intravenous sedation. The Japanese Dental Society of Anesthesiology (JDSA) established “Practice Guidelines for Intravenous Conscious Sedation in Dentistry” in 2017, and these guidelines become standard for routine clinical practices. In Japan, dental school has 6-year curriculum. Lectures and preclinical practices are given to 4th grade students and clinical practices are to 5th grade students. They learn wide range of knowledge and skills for systemic management of dental patients. JDSA has two board systems for dental anesthesiologists; Japanese Board of Dental Anesthesiology (JBDA) and Board Certified Dental Anesthesiology Specialist (BCDAS). BCDAS is authorized by the Ministry of Health, Labour and Welfare, Japan since 2006. The author would expect the development of dental anesthesiology field in Russia and the progress of anesthesiology collaboration system in dental and medical field.