Sedation Record

Starlight Dental Practice ⚙️
👤 Patient Details
👥 Clinical Sedation Team
✅ Pre-operative Safety Checklist
Medical history confirmed & updated Allergies, regular medications, past medical history reviewed
Written informed consent confirmed Consent form signed and patient understands risks & benefits
Emergency equipment & drugs checked Oxygen delivery, suction, flumazenil, defibrillator verified operational
🚗 Responsible Escort
💉 Sedation Agent & Cannula
Aseptic Non-Touch Technique (ANTT) used
📊 Baseline Observations
Snapshot vitals from monitor before starting session.
💓 Live Observations
Connecting…
SpO₂
—
%
Pulse Rate
—
bpm
Blood Pressure
—/—
mmHg
EtCO₂
—
mmHg
Resp Rate
—
br/min
Session Elapsed: 00:00
💉 Drug Administration — Midazolam
Total: 0.0 mg
Time Dose Cumulative Response Action
No doses recorded yet.
🏷️ Batch & Expiry Numbers
💨 Supplemental Oxygen
Time Event Delivery Device Action
No supplemental O₂ logged.
🧠 Sedation Depth & Operating Conditions
Time Wilson Scale Ellis Score
No assessments logged.
📝 Procedure & Clinical Notes
🏥 IACSD 2020 Discharge Checklist
📊 Discharge Observations vs Baseline
Snapshot vitals prior to discharging patient.
🚗 Discharge Handover & Instructions
Written & verbal post-operative instructions provided Care sheet given to patient and responsible escort
Responsible adult escort present for discharge Escort: —
✍️ Clinician Sign-off & Signature
📄 Sedation Session Complete Summary