Conscious Sedation

Conscious sedation is the use of a drug to produce a state of relaxation or anxiety relief to enable treatment to be carried out in a safe, controlled manner. You will NOT be unconscious (as you would be under a general anaesthetic) and you will be able to talk to us and hear what we say.

This method is ideal for

  • Those who are nervous or apprehensive towards their forthcoming oral / facial surgical procedure.
  • Those who require more complex surgery but who still don't need or wish to have a general anaesthetic.

Advantages of sedation over a general anaesthetic

  • There is no need for a hospital admission - we perform surgery under sedation in our purpose-built operating theatre in our outpatient department at Gloucestershire Royal Hospital.
  • You will be seen at a specific appointment time and will usually be able to leave 45 minutes after your surgery has finished.
  • Recovery time is quicker and you are likely to require less time off work.

Who can we sedate in the outpatient department?

  • We follow strict safety guidelines recommended by the relevant National authorities. At the moment we can sedate adults who are generally fit and well and who have no complicating medical problems. Our first stage health questionnaire, that you will complete at your first assessment, will give us all the information we need to make this decisison.
  • If we cannot sedate you in the outpatient department due to a complicating medical condition we can arrange for your surgery to be carried out under sedation in the operating theatre in the main hospital.
  • Please see the inclusion criteria here

Are there any guidelines to follow?

 Conscious sedation - Quality control assessment

The conscious sedation service is currently performed by Thomas Lees (GDC#71642), Associate Specialist in oral & maxillo-facial surgery.

There are several important aspects of care for those that provide conscious sedation services.

1) Practicing in-line with current guidelines / recommendations

The current guidelines that we adhere to are:

"Scottish Dental Clinical Effectiveness Programme". Conscious Sedation in Dentistry. 3rd Edition 2017

"Standards for Conscious Sedation in the Provision of Dental Care". Intercollegiate Advisory Committee for Sedation in Dentistry, 2015

"Safe Sedation Practice for Healthcare Procedures". Academy of Medical Royal Colleges, 2013

In accordance with these and preceeding recommendations our sedation service has been peer reviewed by an expert outwith our department.

Click below for the full text of the review

A logbook of procedures & outcomes is kept, allowing regular audit to be performed. Please see Audit section below.

Thomas has completed a Post-graduate diploma in conscious sedation at Cardiff University and is now using these skills to train two members of the Oral & maxillfcail team to provide sedation to allow this service to expand and develop.

2) Medical emergency preparation - team training

In line with national recommendations we regularly undertake team training in simulated medical emergencies.

Thomas and members of the dental / general nursing staff are ILS certified (Immediate Life Support - Resuscitation Council UK). A yearly rolling of programme of recertification has been established.

All members of the team practice Basic Life Support annually in addition to AED (automated external defibrillator) training.

3) Medical Audit

As with all branches of dentistry and medicine audit is now a full part of our department and individual practice.

It has been recommended for several years that those performing conscious sedatiopn audit their practice and compare themselves to "best-practice". This has been made easier with the publication of "Safe sedation practice for healthcare procedures: Standards & Guidance" by the Academy of Medical Royal Colleges in 2013. This has suggested several reproducible and easily audited topics that a practitioner can carry out.

Since this publication the following audits have been performed. Please click on the links below for the details and results.

 4) Patient feedback

We have completed 2 patient feedback surveys of our conscious sedation service. This was carried out with the assistance of the Trust's PPI (Patient & Public Involvement) team. The questionnaire was given to consecutive patients from 22/05/13 until 08/04/15. All patients were asked to complete and return the questionnaire anonymously to the PPI department in a reply-paid envelope.

The results may be seen here.

The questionnaire used may be seen here.

This survey is being repeated in mid 2017. Results to follow!

 5) Mentoring new practitioners

Due to recent changes in national guidelines we can now expand our service locally. Thomas can now act as a mentor to members of the oral & maxillofacial staff who wish to train to be able to provide sedation independently. The practitioner will attend the national course in conscious sedation for dentistry and then complete 20 mentored cases at Gloucestershire Royal. Thomas is an accredited mentor via the STAC (Sedation Trainer Accreditation Committee) pathway via the royal colleges of surgeons and the Royal College of Anaesthetists.

 Page last updated 27/11/17