From the Journals

Guidelines recommend adding trained personnel for pediatric sedation during dental procedures



An independent skilled observer should be present when pediatric patients undergo dental procedures that require deep sedation or general anesthesia at a dental facility or hospital setting, according to new guidelines released by the American Academy of Pediatrics and American Academy of Pediatric Dentistry.

“Sedation for dental procedures in children and teenagers is generally safe,” Charles J. Coté, MD, lead author of the clinical report who is a pediatrician and a pediatric anesthesiologist, stated in a press release from the American Academy of Pediatrics. “However, we are aware of adverse outcomes when a single dental provider simultaneously performs the procedure and administers deep sedation or general anesthesia for dental procedures. These guidelines ensure the safety of patients who undergo these procedures.”

The full report, which will be published in the June issue of Pediatrics, otherwise remains largely the same as the 2016 guidelines published by AAP and the American Academy of Pediatric Dentistry.

While the previous guidelines had recommended at least one individual with Pediatric Advanced Life Support (PALS) certification be present during a procedure, the new guidelines specify at least two individuals with appropriate certification and training in patient rescue should be in the room during a procedure, regardless of setting, and have the PALS certification as well as be trained in drug administration.

One individual also should be dedicated to monitoring the patient during sedation and capable of performing rescue care, such as administering rescue medications and rescuing a child who is not breathing because of airway obstruction, anaphylaxis, hypotension, or cardiorespiratory arrest. The individual observer should be a physician anesthesiologist, dental anesthesiologist, oral surgeon, or a certified registered nurse anesthetist. “This individual’s sole responsibility is to administer drugs and constantly observe the patient’s vital signs, depth of sedation, airway patency, and adequacy of ventilation,” the authors said.

In addition, the guidelines state sedation must be administered by a qualified anesthesia provider with “sedation training and advanced airway skills,” such as a physician anesthesiologist, dentist anesthesiologist, oral surgeon, or “other medical specialists with the requisite licensure, training, and competencies; a certified registered nurse anesthetist or certified anesthesiology assistant; or a nurse with advanced emergency management skills,” they said.

The operating dentist and the independent observer both must be PALS certified.

The authors reported no relevant conflicts of interest.

SOURCE: Coté CJ et al. Pediatrics. 2019. doi: 10.1542/peds.2019-1000.

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