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Audit of flumazenil use in special care and oral surgery sedation services

British Dental Journal (2021)Cite this article

Abstract

Background The National Patient Safety Agency (2008) has advised against routine reliance on flumazenil for reversal of sedation and encourages regular audit to help identify issues with excessive dosing of midazolam. This multi-centre audit of flumazenil use across both community-based special care and dental hospital oral surgery specialist services was conducted to compare practice against that reported from other UK sedation services.

Methods A six-year retrospective audit was conducted using controlled drug records and patient case notes.

Results Both services used flumazenil at very infrequent levels and far below the agreed standard. The dose of flumazenil and justification for its use was recorded in all records. There was variability in the nature of the justifications between the two services, which likely relates to the differing patient groups seen by the specialties. The majority of cases related to supporting the patient's escort for their journey home; however, this was not always pre-planned.

Conclusions There was a low level of flumazenil use over an extended period of time, supporting the concept of a culture of safe sedation provision in both services. The audit highlighted variation in record-keeping and need for improved communication with patients about escort requirements.

Key points

  • Highlights the importance of record-keeping of flumazenil use in dental sedation services.

  • Demonstrates the low levels of flumazenil prescribing in both a community and hospital setting.

  • Highlights the varying indications for flumazenil reversal of benzodiazepine-based dental sedation.

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Authors and Affiliations

  1. Sheffield Teaching Hospitals NHS Foundation Trust, Oral Surgery, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, South Yorkshire, S10 2SZ, UK

    Claire L. Wilson

  2. Primary Care Dentistry Department, Dental Practice Unit, 19–21 Northumberland Road, Sheffield, S10 2TX, UK

    James Bird

  3. Academic Unit of Oral and Maxillofacial Surgery, Sheffield, S10 2TN, UK

    Sheelah D. Harrison

  4. NHS England, Special Care Dentistry, Heeley Dental Clinic, Gifford Road, Sheffield, South Yorkshire, S8 0ZS, UK

    Nicole A. Dunning

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  1. Claire L. Wilson
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  2. James Bird
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  4. Nicole A. Dunning
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Corresponding author

Correspondence to Claire L. Wilson.

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The authors declared no potential conflicts of interest with respect to the research, funding, authorship and/or publication of this article.

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Wilson, C., Bird, J., Harrison, S. et al. Audit of flumazenil use in special care and oral surgery sedation services. Br Dent J (2021). https://doi.org/10.1038/s41415-021-3001-4

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