For those of you lucky enough to have attended the annual ADA conference in May, you don’t need me to tell you what an excellent day it was. For those of you couldn’t make it this time, let me run through what the day was like and what went on;

On May 25th 2023, the Association of Dental Anaesthetists (ADA) held its 43rd annual conference. As this was the first face-to face conference since 2019, it was hugely anticipated, and a lot of planning went into its creation.

The ADA welcomed the  delegates to the Hallam conference centre in London with the provision of coffee and pastries and a trade fair by our sponsors which this year included Paion, Medtronic and Richmond Finance.

After a welcome by the president Dr. Mohammed Jawar, the first morning session, chaired by Dr. Rudi Swart, kicked off with a talk by Bashar Al Naher titled “The enjoyable dentistry technique”. Having the first morning slot is never an easy one when everyone still half asleep, but Bashar took full advantage of this by introducing us to his hypnosis techniques and inducing a state of deep relaxation in the delegates; not an easy feat in a room full of 50 people! His talk was followed by his colleague Dr Zoita Mandilla with her discussion on “Hypnosedation” and how this can be applied to everyday practice.

After coffee and more delicious pastries, the second morning session, chaired by Dr Sarah Adam, contained two lectures; “Sedating teenagers” by Dr. Sadie Hughes and “Advanced Sedation in Primary Care; Problem or Solution by Dr Azher Ashraf. Dr. Hughes took us through…. And Dr. Ashraf discussed his concerns on limiting choice of available pharmacological agents for conscious sedation; a very current hot topic.

The lunch was excellent with good provision for all dietary requirements as well as some very tasty desserts. During the lunch hour, as well as another opportunity to view the trade fair, the Annual General Meeting of the ADA was held. Among other items on the agenda this resulted in four new recruits to the ADA council.

The first afternoon session was chaired by Dr. Kate Taylor and began with the ADA’s Annual Essay Prize competition. There were three entrants competing for the £250 prize:

  • Dr Jennifer Li with “A Multi-site Service Evaluation of Unsuccessful Conscious Sedation on patients with Learning Difficulties and Autism: Demographic and Trend. 
  • Dr Hamza Hossenally with “can Conscious Sedation using IV Midazolam be effective for 12 to 16 year olds receiving dental treatment in community Dental service? A Service Evaluation
  • Dr Xin Hui Yeo with “Dentist-led Sedation using Fentanyl with midazolam in Dentistry: A 5-year Retrospective Service Evaluation

After these three very interesting presentations, it was the turn of Dr. Rob Endicott to update us on the introduction of the new and exciting sedation drug Remimazolam with a lecture that included some fascinating and very promising case presentations. 

It was then time for an afternoon coffee break and refreshments before the final afternoon session chaired by Dr. Munir Ravalia. This included the very dynamic panel discussion between Dr. Mohammed Jawad and Dr. Joe Omar, called “To starve or not to starve?” The debate was concerning whether or not to fast patients prior to conscious sedation and became quite heated in places with approximately a 50/50 split of opinion. While it may not have changed many of the delegates wholesale in their day-to-day practice, it certainly gave many food for thought going forward.

The prize for the Oral presentation was then awarded to Xin Yeo by Dr Mohammed Jawad which brought to conclusion a very enjoyable day.

 

After welcoming the approximately 85 attendees, ADA president Dr Zelda Swanepoel got the conference underway with a presentation from Dr Judi Humphreys on paediatric hospital referrals for general anaesthesia in the Liverpool area. These already make up a significant proportion of overall paediatric treatment numbers and are set to grow further as the 2017 Commissioning guidelines are being implemented. Worryingly, referral/waiting times – already months rather than weeks – are set to grow alarmingly.

James Roelofse, Professor at no less than four universities (UCL and 3 in South Africa) and a tireless leader in dental sedation and anaesthesia, then presented on the pros and cons of ketofol (a mixture/co-administration of ketamine and propofol) which offers a unique combination of sedation and analgesia where the two agents arguably alleviate each other’s downsides – but there are evident pharmaceutical and legal issues as well as no obvious agreement on the best relative dosage ratio (which can range from 1:1 to 1:10). However, Prof Roelofse presented much data in favour of this drug combination and left everyone with food for thought.

This was followed by a presentation from Professor Simon Wright of the University of Salford on the massive impact that human factors have on team performance, and that an appreciation of this can reduce medical and dental errors.

Professor Roelofse followed with another presentation on pitfalls in post-sedation recovery which emphasised the importance of adequate training for recovery nursing staff . He also stressed the importance of careful patient assessment and selection as this can quite often minimise complications both intra and post-operative.

The lunch break incorporated the ADA’s Annual General Meeting which heard facts and figures that describe a small but vigorous specialty society with a sound financial base. Two new members joined Council, and the date for next year’s ASM was confirmed as Friday 20th November 2020. After lunch Dr Harjit Tagar of King’s College Hospital presented her ground breaking work on producing a cartoon information video to improve the patient’s (and accompanying adult’s) understanding of the pre- and post-operative requirements involved in sedation dentistry. The seemingly simple result has a running time of 2½ minutes but took months to commission, plan and execute, at a cost of around £6,000. It is well worth watching at http://bit.ly/kingsdentalsedation (but please note that KCH retain intellectual property rights).

The next section comprised the ADA’s Annual Essay Prize competition which saw three teams – all from Liverpool – compete for the £250 first prize which was won by Samantha Gee with a presentation on MCDASf (an acronym for the Modified Child Dental Anxiety Scale using face icons, and a handy tool for quantifying patient anxiety as a means of streaming patients towards RA, sedation or GA). She is shown receiving her winner’s cheque from the president in the photo below (top right of the gallery below).

The final section had Dr Keira Mason from Boston Children’s Hospital present first on Safety Aspects in Paediatric Sedation and then on The Future of Paediatric Sedation. A true leader in her field (having led the largest dedicated radiology anaesthesia service in the world for 17 years and set up a nurse-delivered sedation service which delivers more than 3,000 treatments annually), Dr Mason had much to say on both subjects and the majority of the audience was happy to stay on despite the meeting running almost an hour over the advertised closing time. Apparently, the future of paediatric sedation will heavily feature, inter alia, dexmedetomidine and non-pharmaceutical interventions.

After an intense day of updates, about a quarter of the delegates were looking forward to participating in Saturday’s Second ADA Advanced Sedation Techniques workshop entitled ‘YES YOU CAN 2’. A day packed full of hands on and interactive workshops, again featuring our international guests sharing their valuable expertise as well as local experienced sedationists of varied specialities, teaching on e.g. sedation pre-assessment, patient satisfaction and to finish a hands-on workshop with ILS trainer Alan Ralfs on sedation emergencies and complications. At the end of the day participant feedback on this year’s ASM was reported to have been better than ever.