Society for the Advancement of Anaesthesia in Dentistry June 2012 Issue 12

NEWSLETTER

InsideFrom the President ......................Secretary’s Report ......................SAAD Notices...............................SAAD Conference 2012...............SAAD PhD....................................ADA Update..................................BDA Conference...........................Diary Scan....................................

From the PresidentIt is amazing how quickly time seems to pass.There are a number of areas in which membersof the Board of Trustees have been involvedthat I would like to highlight in this report.The activity demonstrates that SAADcontinues to be a vibrant Society whichstrives to advance the cause of pain andanxiety control in dentistry.

The Independent Expert Group for Trainingand Standards for Sedation in Dentistry(IEGTSSD) published the paediatricadvanced sedation techniques syllabusdocument in December 2011. This completesthe trio of documents which the committeehad agreed to publish. The committee hasworked extremely well thanks to the leadershipof David Craig. This committee continues tobe active and is pursuing a number of areaswhere there is still work to be done. SAADcontinues to cover the expenses of this group,whilst not seeking to control the direction ofthe committee’s work.

Paul Averley has been elected to the GeneralDental Council. Our congratulations to himon that success. It is extremely valuable forSAAD to have a member of its Board ofTrustees involved in the General DentalCouncil as a way of ensuring that the voiceof sedation continues to be heard in thatforum.

Nigel RobbPresident of SAAD

The Intercollegiate Advisory Committee onSedation in Dentistry (IACSD), on whichSAAD is represented, has been reconvenedunder the chairmanship of Professor RichardIbbotson. It has a different balance ofmembers from the previous incarnation of thiscommittee that folded in the spring last year.The group’s initial work has been to reviewthe existing guidance and other documentson sedation available in the UK. The ultimateaim is to produce an overarching sedationdocument which would have the support ofall the stakeholders.

SAAD has also been asked to be representedon the working party which aims to updatethe Academy of Medical Royal Colleges andtheir Faculties document, originally publishedin 2000. This was a document that coveredsedation in all areas of medicine and dentistryfor adult patients. It is a sign of our influencethat SAAD is being invited to have a seat atthe table of these groups.

The Board of Trustees will keep membersupdated on developments as and when theyhappen. There will be a presentation aboutthe work of the IACSD during the annualconference in September.

This leads me on nicely to a reminder that ourannual conference will be held on Saturday22nd September in our usual venue of theRoyal Society of Medicine. There is a fullprogramme of hot topics thanks to the effortsof Chris Holden, Paul Averley and MichaelWood. Online registration is now open atwww.saad.org.uk and I urge you to put thedate in your diary. Attendances at theconference have continued to increase overthe years and as a result we are able to invitemore external speakers. Also attendance atthe conference will give about a third of theverifiable CPD recommended in the guidelines.

On the subject of verifiable CPD, the EditorialBoard of Digest discussed the possibility of

introducing a verifiable CPD scheme, as isavailable for some other journals, starting withthe 2013 volume. This scheme will be free tomembers, with further details being madeavailable on the website.

Fiona Wraith, our extremely hardworkingExecutive Secretary, is currently working tomodernise our website, which is one of thefirst ports of call for those looking forinformation about sedation in dentistry.

I hope that by the time this newsletter hitsyour mailbox the British Dental Journal willhave published a response to a letter entitled‘A Contrary View’ written by Dr A P Dobson(British Dental Journal 212;206:2012). Themembers of the Board collaborated in veryrapidly producing a response to some of theissues raised. We hope to be able to continueto respond in this way should the need arise.

I would like to conclude by thanking all theTrustees for their support and hard work aswell as the Staff at the Association ofAnaesthetists who front our office, ToniRichman, Emma Lee and Fiona Wraith fortheir administrative support.

I hope to see as many of you as possible atour annual conference in September.

Nigel RobbPresident

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Francis CollierHon. Secretary of SAAD

National Course in Conscious Sedationfor Dentists, Dental Nurses and DCPs

Online registration:www.saad.org.uk/courses/details

For further details or download anapplication form please go to:

www.saad.org.uk

Enquiries: toni@saad.org.uk07583 039309 (text message)

A scheme for practitioners to trialinhalational sedation in the practice settingis being facilitated by SAAD.

A twelve-month loan (at no charge) of aninhalational sedation machine isavailable to members who have attendeda recent SAAD National Course. Therewill be the option to purchase at adiscounted rate at the end of the trial.For further details please contact:Francis Collier franciscollier@btinternet.com

Dental Students - £300Dental Nurses - £300

Closing date 31 March 2013Drummond-Jackson Prize - £1000

Closing date 31 December 2012Details at www.saad.org.uk

SAAD Notices

Grants are available to aid research inpain and anxiety control in dentistry

Please contactSAADoffice@btinternet.com

Secretary’s Report

RA Machine Loan

This is my first report in the Newsletter sincebeing appointed Honorary Secretary lastSeptember. This has been a busy and activeperiod for the Society, not least in the widerange of subjects covered incorrespondence with members.

CORRESPONDENCESome examples of recent queries whichhave found their way to me by email:

1. Colleagues ask for guidelines and adviceon the use of oral premedication, which maybe prescribed to allay anxiety before a dentalappointment. The dose of premedicantprescribed to take at home, eg. temazepamor diazepam, should be small enough toallow a safe journey to the surgery. Anescort should be provided for the patient,who should be given written pre- and post-operative instructions.This should not beconfused with oral sedation, where a largerdose of a sedation agent, eg. midazolam ortemazepam, is administered by the dentistat the surgery, after whichelectromechanical monitoring, cannulationand the availability of antagonist drugsshould be the norm.

2. I am frequently asked whether patientswith various medical conditions andmedication regimes would be fit for sedation.In general, after sedation assessment andperhaps conferring with medicalcolleagues, the patient should be assignedto an ASA (American Society ofAnaesthesiologists) numerical group.Those who fall within ASA group 1 or 2may well be suitable for sedation in aprimary care setting, but those who are inASA 3 may need to be treated in a clinicallocation where more medical support isavailable.

3. I have been asked whether a trainedsedation nurse is required to support adentist who is acting as sedationist only,where another dental colleague is providingthe dentistry. This is not strictly necessary,but I would suggest that the sedationistensure that the wider dental team, of whichthey are a part, is capable of providingassistance should a sedation- relatedemergency occur.

4. Colleagues expressed concern abouttheir exposure to nitrous oxide pollution insituations where the active scavengingsystem had failed. In this situation theywere being asked to continue to useinhalation sedation, and also where theyfelt perhaps they were being asked to carryout too many inhalation sedations duringthe course of a day. Both cases wereresolved following discussions in theirworkplace, the former with the urgentprocurement of a new motor for thescavenging system, and the latter with theprovision of a personal nitrous oxidemonitor to ascertain daily exposure. Thecurrent financial stringencies to which weare all subject is no reason to accept clinicalpractice which falls below hitherto acceptedstandards.

MENTOR’S LISTThe Mentor’s List is periodically updated,and may be accessed by SAAD membersthrough the website. I am occasionallyasked for advice about how mentoringshould work, and I usually advise peopleinitially to read two relevant articles in the2006 and 2010 editions of SAAD Digest(both accessible on the website) written byDerek Debuse and me respectively.

WEBSITEFiona Wraith, our Executive Secretary, hasbeen further developing the website. It isnow possible to register online for SAAD

courses, as well as providing access tomuch useful information and documents. Itis possible to pay subscription fees andpurchase SAAD literature online. SAADnow has a #tag, SAADuk, with a link fromthe website.

CONTACTSContact may be made with SAAD in the firstinstance through the AAGBI atsaad@aagbi.org. Fiona Wraith, ourExecutive Secretary, may be accessed atSAADoffice@btinternet.com. ToniRichman, who is the Course Administrator,is at toni@saad.org.uk. I am atfranciscollier@btinternet.com.

TRIBUTESI pay tribute to my late predecessor, DerekDebuse, for his kindness and generosity inpreparing me to take over his post upon hisretirement in September 2011. It was myprivilege to serve as Derek’s HonoraryAssistant Secretary since 2009.

No Secretary’s Report would be completewithout a massive vote of thanks to FionaWraith, for her constant good humouredsupport, without which the administrativeelements of the Society would find it difficultto function.

Francis I CollierHonorary Secretary

Essay Prizes

Research Grants

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SAAD Board invites you to our annualscientific symposium. The meeting will be heldat the Royal Society of Medicine, in centralLondon, on Saturday 22nd September. SAADmembers are also invited to attend the AnnualGeneral Meeting of the Society to be heldimmediately following the scientificprogramme.There is a full programme of hot topics withnationally and internationally renownedspeakers. The first session includes

SAAD ConferenceWho Needs Sedation?

22 September 2012

consideration of the difficult sedation case,an update on the Royal Colleges’ position onconscious sedation and a presentation onhow to avoid errors. The second part of theprogramme discusses paediatric conscioussedation, children making choices anddentistry for the vulnerable adult. The finalsession is a topical debate entitled ‘AdvancedConscious Sedation or General Anaesthesia– which is best?’ The debate will be open tothe floor in the final stages followed by avote. This promises to be particularlyinteresting and a lively debate is undoubted.There is verifiable CPD for this meeting aswell as it providing an opportunity to networkwith others who share an interest in dental

sedation. The meeting is supported by thedental trade, which allows us to offer thisconference at a very reasonable rate.Early application is advised as this event isvery popular and the number of participantsis limited. For further information, please referto the enclosed leaflet, and the SAAD websitewww.saad.org.uk where you can registeronline.

We look forward to welcoming you to anexciting conference.

Christopher Holden, Paul Averley andMichael Wood

SAAD Conference Organisers

SAAD PhD inPaediatric DentalSedation

Joe HulinSAAD PhD Student

ADA Update

In February this year I was fortunateenough to be appointed as a PhD studentwithin the School of Clinical Dentistry atthe University of Sheffield. This post wasonly possible because of funding awardedfrom SAAD to support a PhD fellowship inthe broad area of paediatric sedation. Theproposed research will take a psychosocialapproach to the development of evidence-based decision aids to be used in paediatricdental sedation. Such aids are currentlybeing used throughout health care to helpprovide more accurate informationregarding the options and outcomes of thedifferent treatments available and to helpreduce decisional conflict. My initial interestin psychological research dates back to myundergraduate studies at the University ofSheffield, when I first developed a particular

interest in clinical and health psychology.As a result of this experience, I continuedmy studies at Sheffield by undertaking anMSc in psychological research. It wasduring this time that I was first introducedto the School of Clinical Dentistry atSheffield, and undertook my researchdissertation with one my currentsupervisors, Dr Sarah Baker. As a result ofthis experience I was eager to continue myinvolvement in applied research relating todentistry. Having officially started theproject just over one month ago we arecurrently in the very early stages; however,initial reviews of the literature on shareddecision-making are well under way and Iam relishing the opportunity to be part ofexciting developments in the area ofpaediatric dental sedation. I have alreadyhad the opportunity to attend the recentDental Teachers in Sedation GroupMeeting, which was in Sheffield. Mrs ClaireStevens’ keynote lecture on adolescentsedation was particularly informative andrelevant as I hope to recruit study

participants from her sedation clinics atManchester Dental School as well asSheffield and Liverpool Dental Hospitals. Iwill be starting to attend clinics in Sheffieldvery soon, to gain a greater insight into thespecialty of paediatric dentistry andactually observe young patients havingsedation for their treatments. This will makea welcome change from the library!

Joe Hulin

The ADA has been asked join the AdvisoryBoard of the RCoA’s working party onImplementing and Ensuring Safe SedationPractice for Healthcare Procedures inAdults (AoMRC). The purpose of the groupwill be to produce an update to the 2001AoMRC document with the same title. TheAssociation has also been asked by theBDA CDS group to co-present a seminaron GA for adults with special needs in 2013.This year ’s ADA Conference on 13November in London will be more focused

on sedation, and we have managed toassemble a panel of speakers which is notonly very experienced in their particularfields of interest, but who are also excellentand entertaining presenters. Nick Girdlerwill illustrate the versatility of Midazolamas a stand-alone drug, while Ken Ruiz willshare his experience of using Propofol forsedation services in the community. RachelPollard will then address the issue of howto correctly assess those patients withspecial needs that might need sedation.Given the exponential rise in medical anddental claims over the past few years, the

afternoon session is devoted such matters.A representative of the Medical DefenceUnion will tell us about interesting currentand past investigations relating to dentalGA and sedation, and how to steer clear ofsuch problems. Whilst the second sessionwill give us the opportunity to lift thecurtain on what happens once a caseprogresses to a hearing at GMC level. Asalways, the day will conclude with thepresentation of the free papers, which canbe emailed to a member of the ADA council,and finally the AGM.

André du Plessis

SAAD NewsletterPublished annually in June by the Society for the Advancement of Anaesthesia in Dentistry.

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All correspondence should be addressed to SAAD Newsletter, 21 Portland Place, London W1B 1PYTelephone: (01302) 846149 email: SAADoffice@btinternet.com

Diary Scan Compiled by C E Mercer

No responsibility can be taken for any errors or omissions however caused. The Diary Scan is continually updated at www.saad.org.uk/events.

SAAD at the BDA ConferenceAt the BDA Conference Carole Boyle and David Craig gave ademonstration of inhalational sedation on behalf of SAAD. Thiswas supported by our friends at McKesson who supplied the ISMachine. The demonstration attracted a good crowd on bothdays. The audience was treated to an entertaining demonstrationand went away with samples of the new SAAD InhalationSedation leaflet. The BDA have already indicated that SAADwill be invited to next year’s conference.

2012 September

1–2 SAAD Dental Nurse Part II Course London http://www.saad.org.uk/courses

3–5 World Institute of Pain 17th Pain Conference and Practical Workshop Budapest, Hungary http://www.congressline.hu/pain2012/

5–8 ESRA 31st ESRA Conference Bordeaux, France http://esraeurope.org/meetings/esra-annual-congress/

17 EFAAD Conference Moscow http://efaad.squarespace.com/19–21 AAGBI Annual Congress Bournemouth http://www.aagbi.org/education/event/1387

22 SAAD Annual Conference and AGM Royal Society of Medicine, London http://www.saad.org.uk/

October 18–20 European Resuscitation Council International Conference Hofburg, Vienna https://congress2012.erc.edu/index.php/mainpage// 18–21 American Dental Association Annual Session San Francisco, USA http://www.ada.org/session/

November

3–4 SAAD National Course in Conscious Sedation London http://www.saad.org.uk/courses

9–10 ESA Autumn Meeting 3 Prague, Czech Republic http://www.euroanesthesia.org

29–30 UK Society for Intravenous Anaesthesia Annual Scientific Meeting The Royal College of

Physicians, Edinburgh http://www.edinburgh2012.org/

December 2–3 ADSA Chicago Review Swissotel, Chicago, USA http://www.adsahome.org/chicago.html

2013 January

16–18 AAGBI Winter Scientific Meeting QEII Conference Centre, London http://www.aagbi.org/education/event/1662

February

22–23 ADSA Las Vegas Meetings Paris Las Vegas and Bally's Las Vegas http://www.adsahome.org/vegas.html

23–24 SAAD Dental Nurse Part II Course London http://www.saad.org.uk/courses

March

2–3 SAAD National Course in Conscious Sedation London http://www.saad.org.uk/courses

TBA Society for Education in Anaesthesia (UK) Annual Scientific Meeting Royal Society of Medicine,

London http://www.seauk.org/?q=node/8

April 25–27 ADSA Palm Beach Meetings Ritz Carlton Palm Beach http://www.adsahome.org/annual.html

23–27 NWAC World Anaesthesia Convention IV Bangkok, Thailand http://www.kenes.com/nwac2013/

May 14 DSTG Annual Symposium Millennium Stadium, Cardiff http://www.dstg.co.uk/meetings

June

8–9 SAAD National Course in Conscious Sedation London http://www.saad.org.uk/courses

TBA ESA Euroanaesthesia 2013 http://www.euroanesthesia.org TBA GAT Annual Scientific Meeting http://www.aagbi.org/

27–30 WSPC 15th World Congress of Pain Clinicians Granada, Spain http://www2.kenes.com/wspc/Pages/Home.aspx