Implementation of the Indicator of Sedation Need in Oral Surgery

Objectives:
To determine whether patients receiving care under intravenous (IV) sedation currently satisfy the Indicator of Sedation Need (IOSN) assessment tool.
Methods:
Consecutive adult patients (n=88) were recruited prospectively from Oral Surgery consultant clinics in secondary care. Patient anxiety levels were assessed using the Modified Dental Anxiety Scale (MDAS), which was combined with medical and behavioural factors alongside treatment complexity to give an IOSN score (possible range: 3-12). An IOSN score >6 indicates a high need for sedation. Clinicians were blinded to this information and listed patients for treatment under local anaesthetic (LA), IV sedation or general anaesthetic (GA). Treatment modalities were later compared with the IOSN scores.
Results:
Fifty-eight percent (n=51) of participants were female and 42% (n=37) were male, with an age range of 16-85 years (mean 38.8). Sixty-eight percent (n=60) of patients were listed for treatment under LA, 23% (n=20) under IV sedation and 9% (n=8) under GA. When the IOSN score was considered, 50% (n=44) of the total sample were eligible for IV sedation; of these, 2% (n=2) scored above 10, suggestive of a very high need for sedation with possible consideration of GA, although both patients coped with IV sedation. Many who would have been eligible for IV sedation according to the IOSN opted for LA only (n=21). Of the 20 patients who received treatment with IV sedation, 75% (n=15) satisfied the IOSN criteria; for the other 25% (n=5), IV sedation was justified due to treatment complexity and interestingly, these patients all reported low anxiety levels.
Conclusions:
The data reveals that according to the IOSN, half of the patients referred to the department were suitable for treatment with IV sedation but many of these patients successfully completed treatment under LA. This suggests that whilst the IOSN may be useful in decision-making, it may overestimate sedation need.