Patient assessment for anxiolysis (minimal sedation) in dentistry

Careful patient assessment is essential for the safe and effective use of anxiolysis (minimal sedation). The assessment determines the patient’s suitability for anxiolysis as part of planned dental treatment.

To determine the suitability of anxiolysis, assess:

the nature of the patient’s anxiety
the patient’s medical, surgical, dental and medication histories, including allergies
the patient’s cardiovascular, respiratory and airway status
the patient’s exercise tolerance or functional status
the patient’s social circumstances, including intake of alcohol and other psychoactive substances.

Note: If in doubt about the suitability of anxiolysis for a patient, seek medical advice.

Patient groups at increased risk of adverse outcomes with anxiolysis (minimal sedation) outlines patient groups at increased risk of adverse outcomes. If in doubt about the suitability of anxiolysis for a patient, seek medical advice.

Figure 1. Patient groups at increased risk of adverse outcomes with anxiolysis (minimal sedation)

children younger than 2 years
elderly or frail patients
patients with severely limiting heart, cerebrovascular, lung, liver or kidney disease
obese patients
patients with significant obstructive sleep apnoea
patients with a known or suspected impediment to endotracheal intubation
patients with a history of acute gastrointestinal bleeding, particularly if associated with cardiovascular compromise or shock
patients with severe anaemia
patients at risk of aspiration (which may necessitate endotracheal intubation) [NB1]
patients who have had previous adverse events due to anxiolysis, sedation, analgesia or anaesthesia

Note:

NB1: Use clinical judgment to assess the risk of aspiration for each patient.

Source: Australian and New Zealand College of Anaesthetists. Guidelines on sedation and/or analgesia for diagnostic and interventional medical, dental or surgical procedures [PS09]. Melbourne: ANZCA; 2014. [URL]