This section covers sedation and general anesthesia safety for pediatric dentists offering sedation, especially in practices outside of the hospital setting.
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AAPD Policy for Selecting Anesthesia Providers for the Delivery of Office-based Deep Sedation/General Anesthesia
The American Academy of Pediatric Dentistry (AAPD) recognizes that it is the exclusive responsibility of dental practitioners, when employing anesthesia providers to administer office-based deep sedation/general anesthesia, to verify and carefully review the credentials and experience of those providers. An understanding of the educational and training requirements of the various anesthesia professions and candid discussions with potential anesthesia providers can assist in the vetting and selection of highly skilled licensed providers in order to help minimize risk to patients. Click here to view.Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016
This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.Use of Anesthesia Providers in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient
The AAPD intends this guideline to assist the dental practitioner who elects to use a licensed anesthesia provider for the administration of deep sedation/general anesthesia for pediatric dental patients in a dental office or other facility outside of an accredited hospital or ambulatory surgical center. This document discusses personnel, facilities, documentation, and quality assurance mechanisms necessary to provide optimal and responsible patient care.ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists
This overview of sedation and general anesthesia use in the dental office offers color-coded checklists for the delivery of safe and effective sedation and anesthesia based on current clinical guidelines.American Dental Society of Anesthesiology (ASDA) Free APP for Medical/Sedative Emergencies
The ASDA “Ten Minutes Saves A Life” app is the result of several years of work by academic and clinical volunteers at Tufts University School of Dental Medicine. “This is about creating a culture of patient safety in dentistry. […] It’s out there available for any provider.”To find the app, search for “ADSA Ten Minutes Saves A Life!” in Google Play or Apple’s App Store. Within the app, there are flow charts for evaluating emergency events including allergic reactions, choking, hypertension, chest pain, low blood sugar and more. Providers can catalog and track drug expiration dates and also input patient age and weight to personalize needed emergency drug dosages.
Implementation of a Modified WHO Pediatric Procedural Sedation Safety Checklist and Its Impact on Risk Reduction
The authors of this article modified the validated WHO surgical checklist to create a sedation safety checklist, followed by implementation in children’s hospital departments. The checklist aimed to measure compliance to critical safety elements and to reduce sedation-related adverse events. The authors found that checklists help increase process adherence of critical safety elements, and although the overall adverse events decreased, because of such a low baseline, further research is required.Sedation Record
A model sedation record developed by the American Academy of Pediatric Dentistry.Trends in Outpatient Procedural Sedation Part 2: Adverse Effects
An infographic from the Society for Pediatric Sedation presents serious adverse events (SAE) incidence and trends, this graphic highlights the risk factors for SAE’s including procedural drugs used and comorbidities.Stepwise Approach to Procedural Sedation Outside of the OR During COVID-19
This infographic from the Society of Pediatric Sedation presents an approach to seeing patients for procedural sedation during the COVID-19 pandemic.Impact of Obesity on Sedation Diagram
Showing data from a study sedation adverse events (AE) among obese children, this infographic presents key points to inform anesthesiologists treating obese children. Some of the highlights include that obese children have had more adverse events during sedation, were more likely to require intervention, and use of ketamine and pentobarbital had higher odds of adverse events among obese children.Management of Apnea in Procedural Sedation Infographic
This infographic on procedural sedation for kids with apnea touches on defining and diagnosing apnea, risk factors for adverse events for pediatric patients with apnea, incidence of apnea in premature infants, critical points on preventing apnea-related adverse events during procedural sedation, emergency management, and pharmacologic tips. Click here to view.Upper Airway Obstruction
Upper airway obstruction occurs in 1.55% of all sedation encounters. This infographic from the Society for Pediatric Sedation visually highlights the fundamentals of upper airway obstruction, pediatric risk factors, recognition of airway obstruction and management of a situation. -
Risk Reduction in Pediatric Procedural Sedation by Application of an American Academy of Pediatrics/American Society of Anesthesiologists Process Model
This study of an American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) models a pre-sedation and procedure evaluation for reduction of risk in pediatric procedural sedation.Conscious Sedation: Emerging Trends in Pediatric Dentistry
In this article, the authors provide information to practitioners on oral conscious sedation. Some of the topics discussed include factors or problems that may affect anesthesia in pediatric patients, indications for conscious sedation, and how to prepare for a sedation including but not limited to pre-sedation check, emergency, and monitoring equipment. Lastly, they discuss multiple sedation drugs including their route of administration, pharmacokinetics and pharmacodynamics.Sedation and Anesthesia for the Adolescent Dental Patient
This paper outlines procedural sedation procedures for pediatric patients.The Safety of Sedation for Overweight/Obese Children in the Dental Setting
In this article published by the AAPD the authors discuss how obesity is a complicating factor for oral conscious sedation and general anesthesia. Authors found that children who experience 1 or more adverse events during dental sedations had a higher weight and BMI percentile, and they recommend that practitioners should obtain weight, height and calculate body mass index for the patient prior to sedation. -
Pediatric Dental Sedation Outside of the Operating Room (February 5-6, 2022 in San Francisco)
This CE course by Boston Children’s Hospital aims to improve competence and performance in sedation by offering a comprehensive review of dental sedation emergency management.Pediatric Sedation Outside of the Operating Room Virtual Conference 2020. February 5-6, 2022 in San Francisco
This CE course by Boston Children’s Hospital aims to improve competence and performance in sedation by offering a comprehensive review of dental sedation emergency management.Society for Pediatric Sedation (SPS) Sedation Provider Course
These online modules and blended learning courses that offer information on core competencies of safe procedural sedation of children. -
Society for Pediatric Sedation (SPS) Consensus Guidelines: Pediatric Procedural Sedation During the COVID-19 Pandemic and Beyond
Guidelines developed by the Society for Pediatric Sedations address sedations during the COVID-19 pandemic and how to address cases according to their urgency.Procedural Sedation for Infants, Children, and Adolescents. By American Academy of Pediatrics Section on Anesthesiology and Pain Medicine
A comprehensive guide for pre-sedation evaluation and implementation of a procedural sedation protocol, covers medications used for sedation, associated adverse events, and the treatment of these adverse effects.Oral Sedation for Dental Procedures in Children
An evidence-based guide to sedation includes patient assessment, drug selection, protocol steps, emergency management, and the most up-to-date guidelines.Texas Health and Human Services Commission Inspector General Pediatric Dental Sedation Inspection Medicaid Dental Providers
This document was developed following the Texas investigations into sedation-related adverse events in dental practices treating children on Medicaid to determine if the case procedures met the criteria for medical necessity and standard of care.