Section 2 Sedation Practice Environment Information 2A. Sedation practice activity Yes No Comments Sources The practice provides: 1 I Inhalation sedation (IS)……………………………………………………… 2 I Intravenous sedation (IVS)…………………………………………………. single drug (midazolam only)……………………………………... 3 I Section 1.3, CSD 4 I Oral sedation…………………………………………………………………. 5 I Transmucosal sedation……………………………………………………… 6 I Advanced sedation techniques* (if yes, provide details below)…..…….. 7 I ________________________________________________________ The following of patients are treated: Appendix 4, CSD 8 I ASA I or II patients…………………………………………………………… 9 I ASA III patients…………………………………………………………….… Approximate number of sedations provided annually: 10 I Adults (16 years and over)……………………….……….. Section 1.3, CSD 11 I Young people (12-15 years)……………………………… 12 I Children (under 12 years)……….................................... 13 A Children 12 years are only treated using IS……………….. N/A *Currently NHS Scotland does not permit advanced sedation techniques in NHS General Dental Practice.
Section 2 Sedation Practice Environment 2A. Sedation practice activity Yes No Information Sources Comments The practice provides: Section 1.3, CSD 1 I Inhalation sedation (IS)……………………………………………………… 2 I Intravenous sedation (IVS)…………………………………………………. 3 I single drug (midazolam only)……………………………………... 4 I Oral sedation…………………………………………………………………. 5 I Transmucosal sedation……………………………………………………… 6 I Advanced sedation techniques* (if yes, provide details below)…..…….. 7 I ________________________________________________________ The following of patients are treated: Appendix 4, CSD 8 I ASA I or II patients…………………………………………………………… 9 I ASA III patients…………………………………………………………….… Approximate number of sedations provided annually: Section 1.3, CSD 10 I Adults (16 years and over)……………………….……….. 11 I Young people (12-15 years)……………………………… 12 I Children (under 12 years)……….................................... 13 A Children 12 years are only treated using IS……………….. N/A *Currently NHS Scotland does not permit advanced sedation techniques in NHS General Dental Practice.
SPI-Checklist-v2-Sep-2018.docx