DTUK1510

tion of patients June 7-13, 2010United Kingdom Edition thereby avoiding the possibility of a potentiation (exaggerated) effect that could occur when more than one drug is used. With this in mind, the need for an up to date written medical his- tory, with all current medica- tions recorded, is essential in or- der to avoid any interaction with, or potentiation of the patient’s normal medication. In most jurisdictions, dentists who provide sedation are re- quired to undertake postgradu- ate training and to maintain a contemporary level of knowl- edge. Regular refresher courses in cardio-pulmonary resuscita- tion techniques should involve all members of the dental team, and training of the whole dental team under simulated condi- tions, in preparation for a possi- ble real emergency, is an excel- lent risk management strategy. A log should ideally be kept of all such training for each member of the team. Consent Practitioners should take ad- equate steps to ensure appro- priate consent for the sedation procedure itself, in addition to the treatment to be provided. Problems have arisen where pa- tients have had additional treat- ment carried out under sedation without their prior knowledge and agreement. The more accurate the diag- nosis and the fuller the discus- sions prior to treatment, the less potential there is for additional treatment to become immedi- ately necessary while the patient is still sedated; consequently, the less likely the patient will be to complain about a lack of consent. In some parts of the world, the decision to provide addition- al treatment in such situations may not be accepted as appropri- ate, even if taken with the best interests of the patient in mind. Patients have the right of autonomy, which they do not forego simply because they hap- pen to be sedated when their treatment is carried out. Such a situation is more easily accepted in an emergency or where a patient would quite clearly be worse off, if left in pain for ex- ample. It is not always possible to establish the precise treatment plan in advance of the patient being sedated. Because of this, a full discussion should take place with the patient, indicat- ing that this might be the case and the patient’s views should be sought in advance – particularly in respect of any treatment op- tions that they specifically wish to avoid. The obvious difficulty in ob- taining a valid consent from a sedated patient, makes it a sensible precaution (and a for- mal requirement in some coun- tries) that the patient’s consent to both the sedation itself, and to the specific treatment to be car- ried out under sedation, is con- firmed in writing in advance of the procedure. Side effects Clinicians sometimes overlook the mood modification that oc- curs when sedative drugs are used in dentistry. The phar- macological effect leaves the patient with a state of mind that is not entirely normal. Al- though the patient can still re- spond to their environment, and to the commands of others following the administration of conscious sedation, the higher level neurological functions are markedly altered. Most sedative drugs cause a loss of inhibition and some are hallucinogenic. That is the nature of their action. The sci- entific literature contains no authoritative evidence, includ- ing randomised control trials, to establish the frequency of sexual fantasies. Such evidence that does exist suggests that about one in two hundred patients may experience erotic dreams. The benzodiazepines are the drugs most commonly implicated in this phenomenon, but they are by no means the only ones. The dento-legal risk that results from the above is self- evident; allegations of sexual impropriety can have devastat- ing consequences for a hea- lthcare professional, and the media interest is always very high. There have been many such cases around the world which have been associated with dental treatment provided under sedation. Whilst sexual hallucination can be disturbing, it is not a common side effect. A balanced judgement has to be made for ‘The dento-legal risk that results from the above is self-evident; allegations of sexual impropriety can have devastating conse- quences for a healthcare professional, and the media interest is always very high’ page 20DTà