Use of Anesthesia Providers in the Administration of Office-Based Deep Sedation/General Anesthesia to the Pediatric Dental Patient

Abstract

This best practice provides recommendations for dentists who elect to use anesthesia providers in their office or other non-accredited treatment facilities. The scope of this guidance covers personnel, facilities, quality assurance requirements, and documentation of patient care. Anesthesia providers (dental or medical anesthesiologists, oral and maxillofacial surgeons, certified registered nurse anesthetists, certified anesthesiologist assistants) must be licensed, credentialled, and certified in pediatric advanced life support (PALS) or advanced pediatric life support (APLS). Facilities must meet all local, state, and federal laws, codes, and regulations regarding provision of anesthesia services, controlled drug storage, fire prevention, safety and health, and accommodations for disabled individuals. A framework for patient monitoring and required emergency equipment are described. This best practice includes recommendations for documenting indications for deep sedation/general anesthesia, informed consent, patient/parent instructions, the patient’s preoperative health evaluation, a time-based anesthesia record, and recovery notes. Risk management and quality assurance measures are considered essential. Use of in-office anesthesia providers offers alternatives and opportunities for safe, quality compassionate care for pediatric dental patients requiring deep sedation or general anesthesia, especially when access to traditional surgical facilities is limited.

This document was developed through a collaborative effort of the American Academy of Pediatric Dentistry Councils on Clinical Affairs and Scientific Affairs to offer updated information and recommendations to dental practitioners choosing to treat pediatric dental patients in the dental office or other non-accredited ambulatory treatment center using deep sedation/general anesthesia delivered by licensed anesthesia providers.

^{KEYWORDS: ADOLESCENTS, CHILD, ANESTHESIA, GENERAL; ANESTHESIOLOGISTS, DEEP SEDATION, DELIVERY OF HEALTH CARE, DENTAL OFFICES}