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Title: Sevoflurane/nitrous oxide inhalation conscious sedation
Author: Lahoud, George
ISNI:       0000 0001 3603 792X
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2006
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Concern relating to the use of chair dental general anaesthesia in the United Kingdom has been expressed for many years. In four years, 1996 to 1999 there were eight deaths in general dental practices in England of which five were children. These tragic events triggered consensus among policy makers to call for banning the use of dental general anaesthesia outside a hospital setting. Options for preventing anxiety in children who needed chair dental treatment would therefore be limited to the use of local anaesthesia combined with the use of either nitrous oxide inhalation sedation or intravenous sedation. Nitrous oxide sedation is safe but not a potent gas and when it fails, children need either intravenous sedation or general anaesthesia. A suitable alternative to intravenous sedation is desirable for children when the risks of intravenous sedation are considered unacceptable. In search of a new conscious sedation technique that may further reduce the need for general anaesthesia, particularly in children when the use of nitrous oxide sedation has failed and the use of intravenous sedation is considered unsuitable, I investigated the possible use of sevoflurane/nitrous oxide for inhalation conscious sedation (SICS) for children having chair dental treatment. The combination of a variable sub-anaesthetic concentrations of sevoflurane (0.10.3%) in conjunction with a fixed ratio of nitrous oxide and oxygen (40/60%) clinically titrated to allow dental treatment to be carried out by rendering patients more co-operative while remaining conscious and breathing spontaneously, seemed a natural way to improve the success rate of inhalation conscious sedation. The thesis describes a pilot testing of SICS and a randomised controlled study comparing SICS against nitrous oxide alone. The next step was to use balanced conscious sedation with intravenous induction and inhalational maintenance by using SICS to supplement intravenous sedative drugs for patients requiring endoscopic and/or surgical procedures aimed a~ reducing amounts of intravenous sedative drugs needed to produce a balanced sedation.with the benefit of having reduced side effects. Future work involves the development of a safe and practical system for the combination and delivery of the three substances of SICS and the testing of the use of SICS for pain relief in labour.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available