Intravenous sedation for adults with profound acquired brain injury undergoing dental treatment - a seven-year service evaluation

Mili Doshi; Ahmed Kahatab; Louise Gallagher; Ria Prasad; Richard Fitzgerald

doi:10.1038/s41405-024-00289-2

Intravenous sedation for adults with profound acquired brain injury undergoing dental treatment - a seven-year service evaluation

BDJ Open. 2024 Dec 30;10(1):101. doi: 10.1038/s41405-024-00289-2.

Authors

Mili Doshi¹, Ahmed Kahatab², Louise Gallagher³, Ria Prasad⁴, Richard Fitzgerald⁵

Affiliations

¹ Consultant in Special Care Dentistry, Royal Hospital for Neuro-disability, London, UK. [email protected].
² Specialist Registrar in Special Care Dentistry, Surrey and Sussex NHS Health Care Trust, Redhill, UK.
³ Dental Nurse Manager, Royal Hospital for Neuro-disability, London, UK.
⁴ Consultant in Special Care Dentistry, Royal Hospital for Neuro-disability, London, UK.
⁵ Consultant in Special Care Dentistry, Surrey and Sussex NHS Health Care Trust, Redhill, UK.

Abstract

Background: Dental treatment may not be possible for patients with a profound acquired brain injury without pharmacological support. Intravenous (IV) sedation with midazolam is a widely accepted, safe, and effective mode of treatment for people with a disability, but there is limited evidence in this patient cohort.

Aims: This evaluation aimed to review the IV sedation service for patients with profound acquired brain injury within the dental department at the Royal Hospital for Neuro-disability.

Method: This study was a retrospective service evaluation of IV sedation for dental treatment over seven years. Descriptive statistics are presented.

Results: In total, 303 episodes of sedation were undertaken at the Royal Hospital of Neurodisability over seven years. Ninety-two percent were graded with an American Society of Anaesthesiologists (ASA) grade 3, and one-third had a history of stroke. 91% had treatment completed successfully. Complications occurred in 7.9% of cases, but all were minor, with no resulting patient harm (e.g. a transient drop in oxygen saturation).

Conclusion: Dentist-led IV sedation with midazolam is safe and effective for dental treatment for patients with a profound acquired brain injury in a specialised setting with experienced clinicians.