Sedation Need Research Articles

Impact of the mother's voice on sedation need and stress during cardiologic examination of children (SMUSS study): a prospective, interventional, randomised, controlled, monocentric study.

Cardiac catheterisation is crucial for diagnosing and treating paediatric heart diseases, but it is poorly tolerated by small children, infants, and newborns without sedation. This study investigated whether maternal voice during sedation could lower stress and pain in children undergoing cardiac catheterisation and also assessed mothers' stress levels before and after the procedure. This was a prospective, monocentric, randomised, controlled interventional study at the University Hospital Bonn. Children aged 4 years or younger scheduled for elective cardiac catheterisation under procedural sedation and American Society of Anaesthesiologists class between 1 and 3 were eligible. At the end of cardiac catheterisation, the intervention group showed a higher Newborn Infant Parasympathetic Evaluation index with an adjusted mean difference of 9.5 (± 4.2) (p = 0.026) and a lower median Children's and Infants Postoperative Pain Scale score of 2.0 (IQR: 0.0-5.0) versus 4.5 (IQR: 3.0-6.0) than the control group (p = 0.027). No difference in the children's cortisol level was found (p = 0.424). The mothers in the intervention group had a lower cortisol level than those in the control group before cardiac catheterisation (adjusted mean difference: -4.5 nmol/l (± 1.8 nmol/l), p = 0.011). Listening to the maternal voice during cardiac catheterisation could lead to less postoperative pain and significantly lower stress and discomfort level in children. Less pain could reduce the incidence of postoperative delirium.Additionally, mothers perceived involvement as positive. A reduced stress level of mothers can positively influence children and possibly reduce pain and anxiety.

The Effect of Web-based Sedation Management Education on the Knowledge and Practices of Intensive Care Nurses

Aim: The research was conducted to evaluate the effect of web-based education on the knowledge and practices of intensive care nurses about sedation management.
 Material and Method: In this study, which was carried out in a single group, pre-test-post-test design, the knowledge levels and practices of 62 intensive care nurses on sedation management were evaluated. The nurses were given web-based sedation management education, one month after the education, the knowledge levels and practices of the nurses participating in the study on sedation management in intensive care patients were re-evaluated, and the effectiveness of the education was evaluated by analyzing the data before and after the education.
 Results: After the web-based education, it was determined that there was a significant increase in the rate of correct answers to the statements about sedation management by nurses. It was determined that the rate of nurses applying nursing interventions to prevent agitation and reduce the sedation need of patients increased significantly after the education.
 Conclusion: It has been determined that web-based education is an approach that supports increasing the knowledge and practices of intensive care nurses on sedation management. It is recommended that web-based education programs be supported in order for intensive care nurses to perform effective agitation-sedation management.

325: CHILDREN UNDER 24 MONTHS REQUIRE LESS SEDATION ON NIV WHEN FED

Introduction: In the PICU population, enteral nutrition (EN) as well as dexmedetomidine have been described as safe and effective with dexmedetomidine as the primary sedative of choice to improve tolerance of NIV. Methods to increase tolerance of NIV interfaces have been particularly important for patients < 24 months. We aimed to describe the potential association of EN with dexmedetomidine requirements for children on NIV. Here we describe a secondary aim to determine if there is a more pronounced association in the < 24 month population versus older children. Methods: A retrospective chart review was conducted of all children in our PICU acutely supported with NIV for at least 12 hours for a one-year period from April 1, 2019 - March 31, 2020. Data was collected until subjects were transferred out of the PICU, weaned off NIV, required intubation, or completed a max of 7 study days; whichever came first. Statistical comparisons were made using t-tests and chi-square tests for continuous and categorical variables, respectively. Results: 289 subjects were enrolled. 196 were < 24 months and 93 were older. On day 0, there were statistically significant differences (α = 0.05, p-value < 0.05) in the amount of children who received dexmedetomidine and were not fed and those who were fed in the < 24 month (50.7% versus 13.2%) and >25 month group (30.8% versus 11.1%). This continued for the younger group on day 1 with 69% not fed receiving dexmedetomidine versus 27.5% who were fed but lost its association for the older group past day 0. Conclusions: For critically ill children supported with NIV, there was a significant association with requirement of dexmedetomidine for patients who were not fed on day of initiation of NIV as previously presented. In this age-based subgroup analysis, this association was greater in the < 24 month age group than older children, supporting that feeding can potentially decrease sedation need even in this notoriously NIV intolerant group.

Estimating the Need for Sedation in Patients with Dental Anxiety and Medical Complexities Reporting to Tertiary Care Dental Hospital Using the IOSN Tool.

Objectives To provide consistent method for assessment of sedation need among patients undergoing dental treatment based on specific risk factors that is dental anxiety, medical status, and treatment complexity of needed dental treatment using IOSN (indication of sedation need) tool for assisting the clinician in decision making process. Methods A total of 237 patients aged ≥12, ASA I and II were enrolled in the study. A structured questionnaire comprising of three sections was distributed among the participants. Section 1 comprises details about age, gender, literacy level, occupation, monthly income, and previous dental treatment history. Section 2 is based on Modified Dental Anxiety Scale which is a questionnaire comprising of five questions ranging from “not anxious” to “extremely anxious.” The third section was based on using the IOSN tool comprising three components: MDAS (Modified Dental Anxiety Scale) rank score, Systemic Health (ASA status) rank score, and treatment complexity rank scores. The total of three scores was then computed to determine the total rank score which suggested the sedation need. History of past traumatic dental experiences was also inquired from each patient. Results A total of 237 patients aged ≥12, ASA I and II were enrolled in the study, out of which 56.1% were female. Statistical analysis was conducted by using the IBM SPSS Statistics 23 software. Based on the MDAS score, 47/237 (19.8%) participants were found to be highly anxious related to dental procedures. 34.6% of the participants showed to have a high sedation need while performing a dental procedure. The sedation need was found to be significantly associated with the female gender with a significant p value of (p=0.016), higher education status (p=0.016), and history of previous traumatic dental experience (p < 0.001). Conclusion A simple assessment tool can enable clinicians in their decision making to identify patients in need for dental treatment under sedation based on patient-specific risk factors such as past traumatic dental experiences. Need for sedation can be assessed by information on patient anxiety level towards dental treatment, medical history, and complexity of planned dental treatment. The IOSN tool is a simple and quick assessment tool that can be applied for preprocedural assessment of sedation need for dental treatment.

Fine-Needle Aspiration Biopsy of Pediatric Salivary Gland Tumors: Analysis of Patient Tolerability, Sedation Requirement, and Procedural Complication

Objective: Fine-needle aspiration (FNA) biopsy is the standard diagnostic tool recommended by consensus management guidelines for preoperative evaluation of salivary gland tumors in adults. However, its utility in the pediatric population remains debated due to a paucity of data and inherited challenges of pediatric management (patient cooperation, the need for sedation, and procedural complications). Methods: Consecutive series of 92 FNA biopsies of pediatric salivary gland lesions with available procedural data were included for retrospective analysis. Patient demographics, procedural characteristics, and complications were assessed. Results: Sixty-three patients (68%) tolerated FNA without sedation. Sedation need was significantly associated with younger age, concurrent non-FNA procedure requiring sedation, ultrasound guidance, interventional radiologist as the proceduralist, and radiology suite as the facility setting. The sedation rates for children, and early, middle, and late adolescents were 69%, 32%, 12%, and 10%, respectively, with an optimal cutoff point of ≤12 years for age derived from receiver operating characteristic curve analysis. No significant procedural complications were observed. Sedation did not provide significantly better diagnostic yield. Conclusion: FNA biopsy of salivary gland tumors is safe, well tolerated by the pediatric population, and can be effectively performed in an outpatient setting without sedation in most cases. FNA biopsy is a useful tool in the preoperative management of pediatric patients with salivary gland tumors.

The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial.

Introduction:Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are regional analgesic techniques, are successfully used in postoperative pain control after total knee arthroplasty. This study aimed to compare adductor canal block method that was preoperatively used and femoral nerve block method in total knee arthroplasty (TKA) patients who underwent spinal anesthesia in terms of factors effecting patient satisfaction and determine whether these methods were equally effective or not.Methods:A total of 80 patients between the ages of 60 and 75 who were in the American Society of Anesthesia (ASA) physical status of I-III were prospectively included in this randomized study. Patients (n = 40) who received FNB were called Group FNB and patients (n = 40) who received Adductor Canal Block were called Group ACB.Results:Although mean postoperative VAS values were lower in FNB group only in the first hour (p = 0.02) there was no significant difference between the groups in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although Bromage scores were lower in FNB group in the first, second, third, fourth and fifth hours there was no statistically significant difference between the groups (p≥0.05). When mobilization time, patient satisfaction level, time of first analgesia, intraoperative sedation need, and recovery time of sensorial block were compared no statistically significant difference was found (p≥0.05).Discussion:When ACB and FNB that are used for postoperative analgesia in patients who undergo total knee arthroplasty are compared in terms of factors affecting patient satisfaction it is observed that they result in the same level (non-inferiority) of patient satisfaction.Conclusion:We recommend the routine use of ACB method with FNB in total knee arthroplasty. More studies focusing especially on measuring patient satisfaction are needed.

Do state-trait anxiety and previous unpleasant dental experiences predict the need for sedation in women having third molar surgery?

The aim of this study was to examine the need for sedation in women who had or had not had a previous unpleasant dental experience, and to assess possible contributory factors. The sample size required was estimated at 312 subjects. Healthy women listed for the surgical removal of third molars were asked to complete a questionnaire regarding their health, clinical and personal experience, past dental experience, result of the Indicator of Sedation Need (IOSN) scale, and of the Spielberger's State-Trait Anxiety Inventory. The participants were categorised before analysis by the nature of their previous dental experience. The number of participants who required sedation, their mean IOSN score, and the mean degree of state anxiety were significantly higher in the unpleasant experience group. The younger the patient at the time of the experience, the worse the state-anxiety (r=-0.25). The odds that sedation would be needed were 2.24 times higher in the same group. The final model correctly predicted the need for sedation in 75.3% of the cases. Healthy women having third molar surgery who had had a previous upsetting dental experience were more likely to need sedation and had worse state-anxiety than those who had not.

Underwater Insertion Improves Polyp Detection in Young Adults Undergoing Colonoscopy

Introduction: Rates of colorectal cancer (CRC) in adults under age 50 is increasing, leading the American Cancer Society (ACS) to recommend lowering the initial screening age to 45. Little is known about best screening practices in this population. Underwater insertion (UW) has been shown to improve polyp detection rates among older adults. However, its effect on polyp detection in the young is less well understood. Objective: Assess the effect of underwater insertion on polyp detection among young adults undergoing colonoscopy. Methods: Colonoscopy quality data was prospectively collected at our single, tertiary referral center beginning in June 2012. We analyzed all colonoscopies performed between Aug 2014 and June 2018 in patients age 19-49, inclusive of all indications. Procedures were categorized based on insertion type: air/CO2-insufflated (AI) or underwater (UW). The two groups were compared with respect to polyp detection rates, procedural times, and cecal intubation rates. Significance was determined using chi-square test and unpaired T-test. Results: 583 colonoscopies were included in final analysis, including 168 AI and 415 UW procedures. The most common indications for colonoscopy were personal history, abdominal pain, and bleeding. Bowel prep scores were higher in UW group (7.7 vs. 8.1, p=0.02). UW was associated with a significant increase in ADR over AI (5.2% vs. 16.4%, p<0.0001). Overall PDR also improved with UW, though these results did not reach significance (24.4% vs. 31.0%, p=0.08). Similar significant increases in ADR were seen on subgroup analysis by gender in both females (2.1% vs. 14.6%, p<0.0001) and males (7.5% vs. 18.3%, p=0.01). UW also improved detection of both polyps in the left colon (2.1% vs. 10.5, p=0.0002) and right colon (4.3% vs. 9.8%, p=0.03). Procedural times were marginally longer with UW, though this was not significant (see table 3). Conclusion: The ACS has recommended expanding the target CRC screening population to include younger patients. UW has been shown to significantly improve polyp detection and bowel prep scores, and reduce sedation need in the age 50 and older screening cohort. Our results suggest these benefits extend to younger patients. Our results are limited by the retrospective analysis and non-screening indications for procedures. Further prospective studies are needed to assess the role of UW, as well as other techniques and devices, on polyp detection in younger patients.165_A Figure 1. Baseline characteristics of patient population165_B Figure 2. Polyp detection rates with air-insufflation vs. underwater insertion165_C Figure 3. Procedure times and Boston Bowel Prep Scores with air insufflation vs. underwater insertion

Kitten Scanner reduces the use of sedation in pediatric MRI

The use of sedation before a magnetic resonance imaging (MRI) scan is a common practice to overcome motion artifacts and anxiety in children. However, this technique has its drawbacks. We retrospectively compared the number of children undergoing a brain MRI scan with or without sedation before and after the introduction of an educational training protocol using a toy scanner (the Philips Kitten Scanner) and we investigated the effectiveness of this training in relation to children's age and gender. We considered 1461 children between 4 years and 14 years. Of them, 158 had a diagnosis of autism spectrum disorder or attention-deficit hyperactivity disorder and were excluded from further analysis. After the introduction of the Kitten Scanner training protocol, the sedation need decreased by 30% in the total sample group and in children younger than 10 years in particular. Before the training, females were more likely to undergo the MRI examination without sedation as compared to males, while after its introduction this gender difference was no more visible.

ACOG Committee Opinion No. 742 Summary: Postpartum Pain Management.

Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman's ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Because 81% of women in the United States initiate breastfeeding during the postpartum period, it is important to consider the drug effects of all prescribed medications on the mother-infant dyad. Multimodal analgesia uses drugs that have different mechanisms of action, which potentiates the analgesic effect. If opioids are included, a multimodal regimen used in a stepwise approach allows for administration of lower doses of opioids. Given interindividual variation in metabolism of opioids, as well as the risk of maternal and neonatal adverse effects in women who are ultra-rapid metabolizers of codeine, monitoring for excessive sedation and other adverse effects in infants is prudent for women who are prescribed opiates. Although the U.S. Food and Drug Administration recommendations underscore the need for anticipatory guidance regarding opioid effects in all patients, obstetrician-gynecologists and other obstetric care providers should ensure that the application of this guidance does not interfere with pain control or disrupt breastfeeding during the postpartum period. Women with opioid use disorder, women who have chronic pain, and women who are using other medications or substances that may increase sedation need additional support in managing postpartum pain.

ACOG Committee Opinion No. 742: Postpartum Pain Management.

Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman's ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Because 81% of women in the United States initiate breastfeeding during the postpartum period, it is important to consider the drug effects of all prescribed medications on the mother-infant dyad. Multimodal analgesia uses drugs that have different mechanisms of action, which potentiates the analgesic effect. If opioids are included, a multimodal regimen used in a stepwise approach allows for administration of lower doses of opioids. Given interindividual variation in metabolism of opioids, as well as the risk of maternal and neonatal adverse effects in women who are ultra-rapid metabolizers of codeine, monitoring for excessive sedation and other adverse effects in infants is prudent for women who are prescribed opiates. Although the U.S. Food and Drug Administration recommendations underscore the need for anticipatory guidance regarding opioid effects in all patients, obstetrician-gynecologists and other obstetric care providers should ensure that the application of this guidance does not interfere with pain control or disrupt breastfeeding during the postpartum period. Women with opioid use disorder, women who have chronic pain, and women who are using other medications or substances that may increase sedation need additional support in managing postpartum pain.

A review of the indicator of sedation need (IOSN): what is it and how can it be improved?

The indicator of sedation need (IOSN) is a tool that has been devised to help with clinical decision-making, health needs assessment and commissioning purposes for the provision of sedation services. It can potentially increase access for patients to sedation when used as a screening tool, however, there are some shortcomings in the IOSN, such as the fact that it is not speciality specific, that can reduce its efficacy. As such, in its current form the IOSN may not be robust enough to be used as a sole commissioning tool and may in fact create barriers to patients that would benefit from sedation. By addressing these issues and understanding its limitations, the IOSN can be used more effectively for its intended purposes.

Procedural Sedation and Analgesia in Children in Emergency Department—Role of Adjunct Therapies

Objective: To compare sedation efficacy and parent/consultant satisfaction between standard sedation, sedation with music listening, and sedation with Certified Child life Specialists (CCLS) in children undergoing procedural sedation in the Pediatric Emergency Department (PED). Methods: Eligible children, aged 3 - 18 years, were randomly allocated to one of 3 groups: 1) standard sedation; 2) sedation with music listening; 3) sedation with CCLS intervention. All 3 groups received intravenous ketamine. The child life group received age appropriate comforting measures, while the music group listened to music of their choice during the procedure. The primary outcome was sedation efficacy, measured by Ramsay Sedation scale, FACES-P scale and need for re-dosing. The secondary outcome was parent/consultant satisfaction. Results: Fifty nine patients were analyzed (standard sedation: 20; sedation with music listening: 20; and sedation with CCLS: 19). There was no significant difference in mean initial ketamine dosing (1.58 ± 0.44 vs. 1.68 ± 0.36 vs. 1.42 ± 0.47, p = 0.26). There was no significant difference in median Ramsay Sedation scores [6(IQR:4,6) vs. 6 (IQR:4,6) vs. 6 (IQR:5,6)], FACES-R pain score [0 (IQR:0.0) vs. 0 (IQR:0.0) vs. 0 (IQR:0.0)] and need for re-dosing [9/20 (45%) vs. 4/20 (20%) vs. 8/19 (42.1%)] amongst the 3 groups. Parent and consultant satisfaction was high in all 3 groups. Conclusion: Our pilot study did not demonstrate a difference in sedation efficacy or parent/consultant satisfaction when adjunct therapies were used during PSA. Further studies with a large sample size are needed to define the role for such adjunct therapies during procedural sedation in PED.

Utilising a paediatric version of the indicator of sedation need for children's dental care: a pilot study.

To assess the treatment outcomes of using inhalation sedation for comprehensive dental care in children by utilising a modified version of the indicator of sedation need tool. Investigating the outcomes of dental treatment of patients referred to the sedation unit at the Leeds Dental Institute when the paediatric version of the indicator of sedation need (p-IOSN) was utilised. Forty patients of mean age 9.99 (SD=3.14) years were followed up to ascertain treatment outcomes when the p-IOSN was used. Of the total of 40 children included, 20 scored 6 on p-IOSN. Treatment completion rate was 72.5%. Although major differences existed between age and treatment outcomes, they failed to achieve statistical significance. No significant association was found between gender and p-IOSN of any score with any treatment outcome. p-IOSN may be a useful tool that can be used to predict those child patients who would benefit from sedation for their dental treatment. However, the p-IOSN is still in a developmental stage and further research is required prior to its use on clinical grounds.

Assessment of sedation need in a group of patients undergoing dental treatment at a tertiary facility in Lagos State

Aims: The fear of dental treatment and anxiety about dental procedures are prevalent and have an impact on the quality of life of patients and the quality of dental treatment they receive. Sedation can be useful for patients undergoing complex or unpleasant operative procedures but there is no appropriate documentation on the need for sedation for pain and anxiety control in dental clinics in Nigeria. The aim of this study was to assess the need for sedation by a group of patients undergoing dental treatment using the indicator of sedation need (IOSN) assessment tool. Methods: This descriptive study was conducted at the restorative dentistry and oral and maxillofacial surgery clinics of the Lagos State University Teaching Hospital, Ikeja, Lagos. (LASUTH). The ISON questionnaire consisting of the modified dental anxiety scale (MDAS) and the medical and behavioral indicator rank score was used to assess sedation need. Results: Majority of the respondents were female (52.9%); between 21–30 years old (30.5%); had Tertiary education (68.9%); had not had a previous traumatic treatment (60.9%) and required a complex dental treatment (53.0%). Those in the 21–30 years age category, females, secondary school educated and those that had previous traumatic treatment had higher anxiety scores. The female gender (0.024); educational level (0.021); Previous traumatic treatment (0.049); treatment complexity (0.000) and Medical and behavioral rank score (0.000) were significantly associated with a high ISON. Overall 8% of the sample indicated very high dental anxiety (HDA) with total scores above the 19 and above. Conclusion: Using the ISON, 10% of the respondents had a high or very high sedation need. Easy access to conscious sedation in dental offices and knowledge of this access might encourage the fearful among the general population to seek oral care promptly.

Assessing the use of the Index of Sedation Need in oral surgery.

This article evaluates the use of the Index of Sedation Need in oral surgery. Service evaluation and audit. Oral surgery department of a London dental teaching hospital. Patients attending for oral surgery procedures with sedation which had been arranged without reference to the IOSN tool completed the IOSN and a patient questionnaire. Operators completed a similar questionnaire. The IOSN was calculated and the questionnaire responses analysed using SPSS. 56% of the patients in this study (n = 105) were receiving sedation appropriately according to the IOSN tool. When the questionnaire responses were analysed depending on sedation need, no statistical difference was found using Fisher's exact test or Pearson Chi-Square (p <0.05). Fifty percent of patients who had no need for sedation according to the IOSN tool were considered by the operator to have been untreatable without it. This study raises questions over the validity and reliability of the IOSN tool as a method of defining sedation need.

Assessing sedation need and managing referred dentally anxious patients: is there a role for the Index of Sedation Need?

To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety. A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM). Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P <0.02) and dental treatment complexity (P <0.02) predicted planned sedation modality. Functional morbidity was less strong, as a predictor, and was significant at the ten percent level. The IOSN is a useful and valid assessment of sedation need and predicted sedation modality for patients referred with high dental anxiety states and secondly, that component parts of the IOSN add explanatory value in practitioners' choice of planned sedation modality.

The Comparison of Pressure (PSV) and Volume Support Ventilation (VSV) as a 'Weaning' Mode.

The purpose of our study is to compare two different ventilation modes-pressure support ventilation (PSV) and volume support ventilation (VSV)-as the means of weaning. Sixty patients were enrolled in our study. Patients were randomized in to two groups. For the PSV group, FiO2 and airway pressure values were adjusted in order to sustain PaCO2: 35-45 mm Hg, pH>7.32, 6-8 mL kg(-1) TV (tidal volume), and saturation >92%. For the VSV group, FiO2, TV, respiration frequency (f), and peak pressure were adjusted to obtain PaCO2: 35-45 mm Hg, pH>7.32, 6-8 mL kg(-1) TV, saturation >92%, and PO2>60 mm Hg. Every morning, spontaneous breathing was tried in those patients. The patients were extubated after 2 hours of T-piece breathing. The patients who failed spontaneous respiration with the T-piece were returned to mechanical ventilation. Assisted ventilation time (ART), mechanical ventilation time (MRT), total T-piece time (TTT), total weaning time (TWT), and sedation need (SN) values were recorded. "T-test" and "Chi-square" methods were used for statistical analysis. In our study, the mean ART was 82.60 hours for the PSV group and 56.03 hours for the VSV group (p<0.041). TWT was 93.30 hours for the PSV group and 56.03 hours for the VSV group (p<0.035). The mean TTT was 7.67 hours for the PSV group and 3.83 hours for the VSV group (p<0.007). Nineteen patients in the PSV group and 9 patients in the VSV group required sedation during the weaning process (p<0.01). In the weaning period, VSV seems to be more advantageous than PSV.

Allocation of intravenous sedation for minor oral surgery in hospital using the index of sedation need

Background and objective: An audit of patient allocation for oral surgery treatment under local anaesthesia (LA) and intravenous sedation (IVS) in response to the high demand for treatment using IVS. An index of sedation need (IOSN) was introduced as a way of improving the consistency and suitability of patients sent for treatment using IVS.

The indicator of sedation need (IOSN)

Conscious sedation in dentistry is usually indicated because a patient's anxiety can prohibit the necessary dental treatment being undertaken. It may also be indicated because of unpleasant or lengthy treatment or to prevent exacerbation of a patient's medical or behavioural condition by anxiety. The indicator of sedation need (IOSN) tool has been developed to help support dentists in their clinical decision-making and uses information about a patient's anxiety, medical and behavioural status and treatment complexity. The IOSN has been used to measure sedation need and has shown that 5.1% of patients attending general dental practices have a high need of conscious sedation. IOSN has also been used to investigate the need for conscious sedation in the general population among dental practice attenders and those who don't attend. The proportion was found to be 6.7%. Some patients require conscious sedation in order to access dental care. The indicator of sedation need (IOSN) tool helps in the decision-making process.