Guideline on Use of Anesthesia Personnel in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patien

Meghan Sullivan Walsh March 14, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Guideline on Use of Anesthesia Personnel in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Guideline on Use of Anesthesia Personnel in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient

Authors: Clinical Affairs Committee; Council on Clinical Affairs, Sedation and General Anesthesia Subcommittee

Journal: Pediatric Dentistry Reference Manual

Volume (number), Year, Page #’s; V32/NO 6 10/11, 184-186

Major Topic: Guidelines to assist the dental practitioner who elects to use anesthesia personnel for administration of GA or deep sedation in the dental office.

Overview of Method of Research: Electronic Search of current dental and medical literature using specific terms; including the 2006 guideline on pediatric sedation co-authored by the AAP and AAPD.

Findings:

Recommendations:

Personnel : A least three individuals are required for office-based deep sedation/GA. The Anesthesia care provider has the responsibility to administer or direct the administration of the drugs, monitor vitals, airway patency, cardiovascular and neurological status and adequacy of ventilation. The operating dentist and another staff member must be trained in emergency procedures.

Credentials of the anesthesia care provider must include:

1) licensed with appropriate and current state certification

2) completed a 1 or 2 year residency as approved by the ADA or AMA

3) licensed and in compliance with the laws of the state

4) if state law requires a certified nurse anesthetist or anesthesia assistant to function under the dentist’s supervision, the dentist must have completed training in deep anesthesia/GA and be licensed or permitted.

The dentists and anesthesia care provider must comply with AAP/AAPD guidelines. The concept of sedation or GA is introduced to the parents by the dentist which includes instructions and informational materials. The anesthesia care provider with explain the potential risks and obtain an informed consent. Both the dentist and staff must maintain current BLS certification and be well-versed in rescue and emergency protocols. An experienced individual in recovery care must be in attendance in the recovery facility and continually monitor the patient until it is appropriate for discharge. Emergency preparedness must be updated and practiced on a regular basis.

Facilities:

The facilities must meet the guidelines set forth by local, state and federal codes for administration of the deepest possible level of sedation. In addition the facilities will comply with applicable codes, laws and regulations pertaining to controlled drug storage, fire prevention, building construction and occupancy, accommodations for the disabled, occupational safety and health, and disposal of medical waste and hazardous waste. The treatment room will have appropriate monitors and emergency equipment. For deep sedation there must be continuous monitoring of oxygen saturation and heart rate. Temperature monitors and a pediatric defibrillator is required. Emergency equipment must be readily available including suction, oxygen and drugs.

Documentation:

Documentation will include informed consent, instructions to parents, dietary precautions, preoperative health evaluations and any prescriptions. An anesthesia record should include vital signs recorded every 5 minutes, drugs and recovery procedures.

Risk Management:

The dentist must be familiar with the ASA physical status classification. Patients must undergo a preoperative health evaluation.

Key Points: Summary:

Following guidelines during deep sedation/general anesthesia is crucial to minimize the risks of sedation to our patients.

Assessment of the Article: Succinct and thorough.