Sedation safety has always been a critical concern at Dentistry for Children. Sedation is a serious word. It means “the act of calming by administration of a sedative. A sedative is a medication that commonly induces the nervous system to calm.”
Likewise, general anesthesia means: “a state of unconsciousness produced by anesthestic agents, with absence of pain sensation over the entire body and a greater or lesser degree of muscular relaxation; the medicines producing this state can be administered by inhalation, intravenously, intramuscularly, or rectally, or via the gastrointestinal tract.” Either sedation or general anesthesia would only be recommended for serious dental surgery.
However, both of these definitions only mean one thing to most parents: Your child will be put to sleep for surgery to prevent pain and to make the procedure possible.
Thus, if your child needs sedation for a dental procedure, we know you will be very concerned.
Now we are proud to announce that very recently in 2019, the AAP and the AAPD (American Academy of Pediatric Dentistry) have updated the rules for safety in sedation in dentistry.
Sedation safety has always been carefully mandated. However, “recent deaths in the dental setting and concern over the growing use of inadequate supervision during sedation have prompted changes. Therefore, the AAP in conjunction with the American (AAPD)” has created requirements for greater supervisory controls.
Sedation Safety Updated from 2016 Procedures
Now the guidance recommends that at least 2 individuals with very specific sedation training and credentials be present.
- The two individuals must be in the room with any pediatric patient who will be placed under deep sedation or general anesthesia.
- Likewise, they must be present while your child is undergoing deep sedation or general anesthesia for dental treatment in a either “a dental facility hospital or surgical center.”
New Specific Guidelines for Your Child’s Sedation Safety
At a dental facility or a hospital, the new guidelines mandate that “an independent observer — with no additional responsibilities — must be present and skilled to assist with any medical emergency.”
Moreover, both the operating dentist and the independent observer should have the official certification of PALS. This is also termed Pediatric Advanced Life Support (PALS).
- Parents will be happy to know that the reviewed, revised and reformed regulations 2019 also clarify that a qualified anesthesia provider must give your child the sedation.
- This means that your child should receive sedation only from this exclusive list: a medical anesthesiologist, a certified registered nurse anesthetist, dentist anesthesiologist or second oral surgeon.
- At Dentistry for Children, we believe this revised policy really puts safety first in the minds of all concerned with sedation and a dental procedure.
Renewed Concern and a Reformed Report
Reviewed once in 2016, now the clinical report, Guidelines for Monitoring and Management of Pediatric Patients Before, During and After Sedation for Diagnostic and Therapeutic Procedures from the AAP replaces the “personnel” section of the old 2016 rules.
Differences between Old and New Guidelines
Parents and caregivers will likely be happy to know the new two-person mandate replaces the old one-person rule. To put it clearly, 2016 rules for sedation safety only called for one trained person to observe the patient during deep sedation. Also, the old rules did not specify the need for an anesthesia-trained provider.
Folks, these are serious changes, strictly designed for your child’s safety under the rigors of dental sedation for surgery. Thus, we can see the improvement in the safety factors of the new guidelines. Obviously, it is safer for two trained people in charge of your child’s sedation than one. Likewise, all of us would want a certified anesthesia-trained provider in charge of drug administration any time sedation is involved in a child’s treatment.
Safety is in the Details
The dental report, “Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures”details the new procedures for using sedation during a child’s dental surgery. However, we know it can be difficult to read or scan the details. Yet we know parents desire this detailed information.
Parents and Caregivers: Our List for Sedation Safety
First and foremost, we believe there must be a careful pre-sedation evaluation of your child. Before considering dental surgery, Dentistry for Children must determine your child’s underlying medical or surgical conditions.
This must include the following:
- Complete a Pre-sedation Examination and evaluate the medical history
We must know if the child has other conditions that could increase the risk of sedating medications. Both the risk of sedation and the actual testing could be increased by not closely follow pre-exam fasting requirements.
- Appropriate fasting before the required surgery is also essential.
- A focused airway examination must also be completed prior to surgery. We must know if your child has large tonsils. They are sometimes referred to as “kissing” tonsils.
- Additionally, any other anatomic airway abnormalities must also be determined. Any potential problem that can cause obstruction of the air passageways could be dangerous during surgery.
Sedation Safety During the Procedure
Rest assured, your child’s dental-surgery team will have a clear understanding of the effects, rate, duration, and possible reactions of the required medication. Additionally, we will be alert to possible drug interactions if your child is on other medications. In the language of the report, your child’s dental-surgery team will have a “clear understanding of the medication’s pharmacokinetic and pharma-co-dynamic effects.” To know more about the pharmacology of sedation, in-depth readers might want to read all the details in the new report, linked above.
To put it simply, these safety concerns are part of the protocol for dental surgery with Dentistry for Children.
- Your child’s team will have appropriate training and skills in airway management. This will allow the rescue of the patient in case of complications.
- Your child’s facility will have age-and size-appropriate equipment. This means child-size airway management and venous access equipment will be on hand.
- Likewise, there will be appropriate medications and reversal agents, nearby.
- According to the new guidelines, we must have sufficient trained staff available. Not only will we be concerned with accomplishing the procedure but also with the monitoring of our helpless and sleeping patient.
Post Surgical Sedation Consideration
After-sedation: After surgery, the monitoring does not stop.
- We must monitor your child with care in the recovery stage.
- Discharge from our care will not begin until your child returns to the pre-sedation level of consciousness.
- Only then is it safe to discharge your child from medical and dental supervision.
- And we will always give you appropriate discharge instructions to follow after the surgical procedure.
Goals of Sedation and Safety
Why would a dentist want to sedate your child or give general anesthesia to your child? Perhaps parents should know that there are specific objectives when a dentist recommends sedation. The goals of sedation in the pediatric patient for diagnostic and therapeutic procedures are as follows:
(1) Our number one concern when it comes to the sedation and surgery is to protect your child’s safety and welfare.
(2) Naturally, we seek to “minimize physical discomfort and pain.”
(3) With sedation, we always want to control your child’s anxiety. Sedation can minimize psychological trauma.
(4) You might not have ever given it deep thought. But, amnesia is a gift of sedation also. We are delighted when we can maximize the potential for your child to forget pain and anxiety. We love it when a child wakes up and says, “Okay, when are you starting my operation?” Now, that’s a fine kind of amnesia.
(5) And a very important objective of any type of sedation is control. We know we need to modify behavior and/or movement. Thus, we can complete the surgical procedure with complete safety. We want to see that your child is happy, conscious- and smiling.
(6.) When the procedure is over, our ultimate goal is to return your little one into a state of safety and security.
We felt this information about the new sedation safety rules was vital to concerned parents. We know that this particular blog is not as entertaining as some of our articles. We just want you to know what to expect when sedation is involved in your child’s dental procedure.
Likewise, we are highly committed to our patients’ safety at every level. And most assuredly so when it comes to sedation safety. We’re happy these guidelines were reviewed, revised and reformed.
One Last Thing:
As the summer heats up, we remind you to maintain a brush and floss schedule in spite of all your fun activities. As always, we wish you “Happy Brushing!”