Outcomes of a mobile paediatric dental intravenous sedation service in primary care: four-year results
Main Article Content
Abstract
Background: In 2020 a private mobile paediatric intravenous sedation (IVS) service was established for low-risk children in the south-east of England in line with UK Standards for dental sedation. This study aims to assess the outcomes of this service over a four-year period.
Materials and methods: A retrospective evaluation was carried out, including all paediatric dental patients sedated by the IVS service between the1st October 2020 and 30th September 2024.
Results: A total of 274 sedations were included. The mean age was 8.99 years old. No serious adverse events occurred. Eight patients (2.9%) experienced transient post-sedation nausea/vomiting. A total of 271 patients were successfully sedated, a success rate of 98.9%.
Conclusion: This IVS service has been established successfully, with no serious adverse events observed. Parental feedback was overwhelmingly positive. By utilizing moderate sedation, the IVS service offers paediatric patients a safe, outpatient alternative to general anaesthetic for dental procedures. This service addresses an important gap in dental care for children. Expansion of the IVS program could have a major impact on the waiting lists for general anaesthetic paediatric dental procedures in England.
Keywords:
• With comprehensive risk assessments, quality control measures implemented and regular patient feedback it is possible to provide effective multidrug moderate intravenous sedation (IVS) without serious adverse events, for dental procedures in primary care to a level expected in an acute NHS Trust. • This out of hospital IVS service, has been shown to be a successful treatment modality in low-risk children. • IVS can be used for a variety of dental procedures, including restorations, extractions, orthodontic surgical procedures and soft tissue surgery in children. • The widespread provision of IVS may ease pressure on dental hospital general anaesthetic waiting lists.
Article Details
How to Cite
SWART, Rudi; ROBACK, Mark G.; ANAND, Prabhleen.
Outcomes of a mobile paediatric dental intravenous sedation service in primary care: four-year results.
Medical Research Archives, [S.l.], v. 13, n. 1, jan. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6064>. Date accessed: 20 apr. 2025.
doi: https://doi.org/10.18103/mra.v13i1.6064.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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24. Cosgrove P, Krauss BS, Cravero JP, Fleegler EW. Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Annals of Emergency Medicine. 2022;80(6):485-496. doi:10.1016/j.annemergmed.2022.05.002
25. Spera AL, Saxen MA, Yepes JF, Jones JE, Sanders BJ. Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients. Anesthesia progress. 2017;64(3):144-152. doi:10.2344/anpr-64-04-05
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27. Kirby J, Walshaw EG, Yesudian G, Deery C. Repeat paediatric dental general anaesthesia at Sheffield Children’s NHS Foundation Trust: a service evaluation. British Dental Journal. 2020;228(4): 255-258. doi:10.1038/s41415-020-1256-9
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https://www.prosaconference.com/pediatric-sedation-provider-course/
https://www.england.nhs.uk/publication/clinical-guide-for-dental-anxiety-management/
2. Landes DP. The provision of general anaesthesia in dental practice, an end which had to come? British Dental Journal ; volume 192, issue 3, page 129-131 ; ISSN 0007-0610 1476-5373. January 2002. doi:10.1038/sj.bdj.4801313
3. NHS England’s Office of Chief Dental Officer England published Commissioning Dental Services: Service standards for Conscious Sedation in a primary care setting. Updated 2017. Accessed November 1, 2024.
http://www.saad.org.uk/Documents/dental_commissioning_guide_service_standards_conscious_sedation.pdf
4. Ministers need to act as COVID sees child tooth extractions backlog surge. British Dental Journal. 2022;232(10):679. doi:10.1038/s41415-022-4318-3
5. Intercollegiate Advisory Committee for Sedation in Dentistry. Standards for conscious sedation in the provision of dental care. Updated 2020. Accessed November 1, 2024.
https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/standards-for-conscious-sedation-in-the-provision-of-dental-care-and-accreditation/
6. American Society of Anesthesiologists: Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Accessed November 1, 2024.
https://www.asahq.org/standards-and-practice-parameters/statement-on-continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedation-analgesia
7. Care Quality Commission: Dental mythbuster 10: Safe and effective conscious sedation. Updated July 3, 2023. Accessed November 1, 2024.
https://www.cqc.org.uk/guidance-providers/dentists/dental-mythbuster-10-safe-effective-conscious-sedation
8. Resuscitation Council UK: Paediatric emergency algorithms and resources updated March 2024. Updated March 2024. Accessed November 1, 20204. https://www.resus.org.uk/sites/default/files/2024-03/RCUK%20Paediatric%20emergency%20algortihms%20and%20resources%20Mar%2024%20V2.2.pdf
9. Resus Council UK: EPALS (European Paediatric Advanced Life Support) Course. Accessed November 1, 2024.
https://www.resus.org.uk/training-courses/paediatric-life-support/epals-european-paediatric-advanced-life-support
10. Resus Council UK: ALS: 2 Day Course (Advanced Life Support) Course. Accessed November 1, 2024.
https://www.resus.org.uk/training-courses/adult-life-support/als-2-day-course-advanced-life-support
11. Resus Council UK: PILS (Paediatric Immediate Life Support) Course. Accessed November 1, 2024. https://www.resus.org.uk/training-courses/paediatric-life-support/pils-paediatric-immediate-life-support
12. Lozano-Díaz D, Valdivielso Serna A, Garrido Palomo R, Arias-Arias Á, Tárraga López PJ, Martínez Gutiérrez A. Validation of the Ramsay scale for invasive procedures under deep sedation in pediatrics. Paediatric anaesthesia. 2021;31 (10):1097-1104. doi:10.1111/pan.14248
13. Aldrete JA. The post-anesthesia recovery score revisited. Journal of Clinical Anesthesia ; volume 7, issue 1, page 89-91 ; ISSN 0952-8180. January 1995. doi:10.1016/0952-8180(94)00001-k
14. Roback MG, Green SM, Andolfatto G, Leroy PL, Mason KP. Tracking and Reporting Outcomes Of Procedural Sedation (TROOPS): Standardized Quality Improvement and Research Tools from the International Committee for the Advancement of Procedural Sedation. British journal of anaesthesia. 2018;120(1):164-172. doi:10.1016/j.bja.2017.08.004
15. General Medical Council: Guidance for Appraisers. Accessed November 1, 2024.
https://www.gmc-uk.org/-/media/documents/guidance-for-appraisers---pms-45189197.pdf
16. Couloures KG, Beach M, Cravero JP, Monroe KK, Hertzog JH. Impact of provider specialty on pediatric procedural sedation complication rates. Pediatrics. 2011;127(5):e1154-e1160.
doi:10.1542/peds.2010-2960
17. Smallman B. Pediatric sedation: can it be safely performed by non-anesthesiologists? CURRENT OPINION IN ANAESTHESIOLOGY. 2002;15(4):455-460. Accessed December 2, 2024. https://research.ebsco.com/linkprocessor/plink?id=2d9bd699-9270-3446-a9c5-beaceeda3deb
18. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse Sedation Events in Pediatrics: Analysis of Medications Used for Sedation. PEDIATRICS -SPRINGFIELD-. 2000;106(41):633-644. Accessed December 2, 2024. https://research.ebsco.com/link
19. Bhatt M, Johnson DW, Chan J, et al. Risk Factors for Adverse Events in Emergency Department Procedural Sedation for Children. JAMA pediatrics. 2017;171(10):957-964. doi:10.1001/jamapediatrics.2017.2135
20. Kamat PP, McCracken CE, Gillespie SE, et al. Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database. Pediatr Crit Care Med. 2015;16(1):11-20. doi:10.1097/PCC.0000000000000273
21. Grunwell JR, Travers C, Stormorken AG, et al. Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium. Pediatric critical care medicine. 2017;18(8):e356-e363. Accessed December 13, 2024.
https://research.ebsco.com/linkprocessor/plink?id=0a6ca396-946b-3ae9-8e4b-7ad492207b18
22. Cravero JP, Havidich JE. Pediatric sedation - evolution and revolution. PEDIATRIC ANESTHESIA. 2011;21(7):800-809. Accessed December 2, 2024. https://research.ebsco.com/linkprocessor/plink?id=618c749a-f693-370e-b61a-ed3facc0f0df
23. Bellolio MF, Puls HA, Anderson JL, et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis. BMJ Open ; volume 6, issue 6, page e011384 ; ISSN 2044-6055 2044-6055. January 2016. doi:10.1136/bmjopen-2016-011384
24. Cosgrove P, Krauss BS, Cravero JP, Fleegler EW. Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Annals of Emergency Medicine. 2022;80(6):485-496. doi:10.1016/j.annemergmed.2022.05.002
25. Spera AL, Saxen MA, Yepes JF, Jones JE, Sanders BJ. Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients. Anesthesia progress. 2017;64(3):144-152. doi:10.2344/anpr-64-04-05
26. Lawson J, Owen J, Deery C. How to Minimize Repeat Dental General Anaesthetics. Dent Update. 2017;44(5):387-395. doi:10.12968/denu.2017.44.5.387
27. Kirby J, Walshaw EG, Yesudian G, Deery C. Repeat paediatric dental general anaesthesia at Sheffield Children’s NHS Foundation Trust: a service evaluation. British Dental Journal. 2020;228(4): 255-258. doi:10.1038/s41415-020-1256-9
28. Snow and Sedation Conference. Accessed December 13, 2024. https://snowandsedation.com
29. Society of Pediatric Sedation Provider course. Accessed November 1, 2024.
https://pedsedation.org/offerings/sedation-provider-course/
30. PROSA Pediatric Sedation Provider Course. Accessed November 1, 2024.
https://www.prosaconference.com/pediatric-sedation-provider-course/