Review of monitors and monitoring equipment during sedation with emphasis on clinical applications 4/9/10

Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence

Article title: Review of monitors and monitoring equipment during sedation with emphasis on clinical applications
Author(s): The mack Daddy….Stephen Wilson, DMD, MA, PhD(playa hatin degree)
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 1995. 17:7 413-418
Major topic: Different monitors that can be/should be used during dental sedation
Overview of method of research: Review

Findings: How many monitors should be used during dental sedation? Which kind of monitors should be used. The correct answer is, it depends. The best, basic answer is that an operator needs to know their limits, be prepared to handle one level of sedation higher than they intend, and be able to work and understand their monitoring systems.

Pulse Oximetry-Gold standard for monitoring. It is used to measure the oxygen sat. in the blood(absorption and ratio of red and infrared light represent degree of hemoglobin o2 sat.), and heart rate. Patient movement, nail polish, pressure on the vessels can affect the pox’s reading. While it’s important to keep these variables in mind...TRUST YOUR PULSE OX!!! Don’t dismiss bogus readings immediately. It may be telling you something is wrong, very wrong. It’s extremely safe, easy to use, relatively quick with info, and give you vital information about your patient’s breathing...or lack there of. Pox’s can be placed on the fingers, toes, and even ear lobes.

Blood Pressure Cuffs- Records BP and heart rate. It’s important to use the correct size cuff, otherwise the readings will be inaccurate. It’s safe, easy to use, and gives quick, important info. Can be used pre-op, intra-op, and post op.

Capnography- Not widely used, and even less understood, a capnograph determines expired CO2. Main stream units are used for intubated patients, and side stream for non-intubated patients. A small nasal probe is inserted 2-3mm into the nasal aperture. It’s important that there is no blockage, or obstruction of the nasal piece(duh). It’s easy to use, provides rapid info, and gives you a direct determination of airway patency.

Precordial Stethoscope- Also called a “bell”, it gives you the sounds of the heart and lungs, depending on placement. These are simple to use, non-invasive, durable, and cheap. Most importantly, it gives you immediate feedback on the patients breathing. Seasoned veterans can predict laryngospasms seconds before they occur when using precords. Good stuff.

Key points/Summary: Dr. Wilson goes on to discuss how he believes that sedation “depth” should be redefined by the AAPD(in table 2 of the article he outlines his plan). He discusses how in the near future there will be new kinds of monitors, even using brain mapping functions along with other sensitive measures. At the end of the day, the practitioner who sedates children must embrace the concept and understanding of a continuous, multi monitoring system.

Assessment of Article:Good review of necessary monitors, how they work, and their clinical application. GO STEVO!!