Procedural sedation for people with developmental disability

In some cases (eg if nonpharmacological behaviour support strategies are not possible or sufficient), oral or intravenous sedation or general anaesthesia may be required to enable a person with developmental disability to undergo a dental procedure. For general advice on anxiolysis (minimal sedation) for dental procedures, see the Oral and dental guidelines.

Conscious sedation and general anaesthesia in people with developmental disability can be complicated by the following medical and social factors:

• complex congenital defects and ongoing concerns with cardiovascular health
• respiratory dysfunction especially risk of aspiration and obstructive sleep apnoea
• altered airway anatomy, kyphoscoliosis and atlantoaxial instability making airway access difficult
• undiagnosed underlying systemic disease (eg due to the high incidence of undiagnosed primary disease in those with developmental disability)
• difficulties adhering to fasting times and inability to take recommended premedication without food
• clinical obesity, hepatic and renal dysfunction leading to unpredictable drug uptake and clearance
• tolerance to sedative medication (eg when the drug has been used long term), or synergistic effect with current medication
• challenging behaviour on emergence from sedation and general anaesthesia.

Sedation in a dental practice must be undertaken by a board-registered dental sedationist or anaesthetist, with access to appropriate facilities. Some people with developmental disability are too medically complex to be treated in a community clinic, and might require day surgery or hospital admission.

If multiple interventions are required for a person with developmental disability, it may prudent to advocate for these to be undertaken with one anaesthetic if possible. A planned general anaesthetic for dental treatment might present a good opportunity for screening blood tests (eg in those with a needle phobia). Hospital admission can be planned using this Admission to Discharge template developed in New South Wales for people with intellectual disability.