The board of trustees society for the advancement of anaesthesia in dentistry

摘要

Dr A. P. Dobson responds to the letters from A. J. Caen and SAAD: I welcome the opportunity to respond to some of the points raised by my letter, and thank the authors for their interest. The main thrust of my letter was the view from a hospital anaesthetist who is not infrequently requested to provide deeper levels of sedation beyond the 'conscious sedation' level referred to by Mr Caen and the SAAD Board of Trustees. I reiterate, that when asked to provide this service, after discussion with patient and surgeon, all concerned usually agree that general anaesthesia is the best and safest option: the surgeon has optimal operating conditions, the anaesthetist can objectively and safely monitor the vital signs (including capnography, a very sensitive early indicator of upper airway obstruction that can occur with deeper levels of sedation), and the patient is blissfully unaware of the whole process. This form of dental anaesthetic is usually performed using a laryngeal mask airway, negating the potential problems associated with endotracheal intubation to which Mr Caen alludes. Patients who do require intubation are usually those requiring more complex or lengthy procedures, or in whom airway difficulties are anticipated. Both of these groups, I would suggest, would be unsuitable candidates for conscious sedation techniques in the community. I feel that if a patient has been thoroughly assessed and is deemed unsuitable for conscious sedation, that rather than asking specialist teams, be they in hospital or specially equipped health centres, to provide deeper levels of sedation necessitating more sophisticated drug regimes, that this group would be probably be better served by receiving a general anaesthetic in a hospital setting. Neither option is entirely without risk, but at least the risk associated with general anaesthesia is quantifiable and minimal.