- Adequate procedural sedation
- Protect your thumbs
- Firm downward and posterior pressure
- Post procedure care and advice.
- Ensure no contraindications to procedural sedation
- Ensure no temporomandibular pathology
- Ensure airway competent senior is available to manage airway
- Procedural sedation
- Ketamine 0.5mg/kg
- Midazolam 1mg
- Fentanyl 50microg
- Pad thumbs and place over lower molars, grasp mandible with fingers in a reverse jaw-thrust position.
- Apply firm downward and posterior pressure to relocate jaw.
Post Procedure Care
- Post sedation observation
- Bandage head to ensure patient keeps jaw closed
- Advise to avoid driving for 12 hours.
- Advise to avoid foods that require chewing for 48 hours.