Guidelines - Deep Sedation / GA

Resident’s Name: Joanne Lewis Date: December 11, 2009

Guideline on Use of Anesthesia Care Providers in the Administration of In-office Deep Sedation/General Anesthesia to the Pediatric Patient

Background

- Many pediatric dentists would like to provide deep sedation/general anesthesia outside of the traditional surgical setting.

- Utilizing deep sedation/general anesthesia in the dental office offers benefits for the patient and the dental team.

- It is well documented that treating the patient in an appropriate outpatient facility is a safe and viable approach.

Recommendations

- In-office deep sedation/general anesthesia requires at least 3 people – the anesthesia care provider, the treating dentist, and an assistant.

- It is the responsibility of the treating dentist to verify the credentials of the anesthesia care provider.

- The operating dentist and clinical staff need to maintain current expertise in basic life support. An individual experienced in recovery care must be in attendance until the patient exhibits stable vital signs for discharge. The staff of the treating dentist must be well versed in emergency protocols.

- The facilities in which the dentist practices must meet the guidelines and appropriate state codes for administration of the highest possible level of sedation/anesthesia.

- Minimal monitoring equipment for deep sedation includes a blood pressure monitor, pulse oximeter, precordial stethoscope, capnograph, and electrocardiograph. In addition, for general anesthesia, a temperature monitor and pediatric defibrillator are needed.

- Documentation requirements vary from state to state; however, at a minimum, vital signs, drugs used, and recovery period need to be documented.

- High-risk patients should be treated in a facility properly equipped to provide for their care.