By Angus C. Cameron and Richard P. Widmer (Eds.)
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Sensations of analgesia Children are very open to suggestion. Their thoughts and behaviours can be guided by the dentist. Describe (suggest) the sensations that the child will feel: • Initial ‘heaviness’ or sinking into the chair. • Tingling and numbness of the extremities. • A warm sensation and a feeling of ‘lightness’ or floating off the chair with increasing depth of analgesia. Determining levels of sedation • Once local anaesthesia has been administered successfully, the N2O should be lowered to around 30% and maintained at this level.
Nose breathing). = 30–45-min treatment time. Conscious sedation The term ‘conscious sedation’ has been used in the past to imply a patient who is awake, responsive and able to communicate. This verbal communication with the child is an indicator of an adequate level of consciousness and maintenance of protective reflexes. In clinical practice, however, sedation (conscious sedation, deep sedation and/ or general anaesthesia) is a continuum. Any technique which depresses the CNS may result in a deeper sedation state than intended, and consequently, clinicians who sedate children require a much higher level of skill with a particular technique, the relevant training and experience and the proper qualifications with the relevant regulating authority.
This assessment must include: • A thorough medical and dental history (including current medications, previous hospitalization and past operations). Patient medical status (see ASA classification, below). 2 Large tonsils cause a significant risk of airway obstruction. 3 Resting vital signs in children Age Heart rate (beats/min) Blood pressure (mmHg) Respiratory rate (breaths/min) Neonate 120–170 75–85/45 45–60 2–4 years 110–130 90/50 40 4–6 years 100 100/60 30 10 years 90 110/60 25 15 years 80 120/65 12 • • History of recent respiratory illness or current infections.