Sedation for dental procedures in children and teenagers is generally safe. However, recent deaths in the dental setting and concern over the growing use of inadequate supervision during sedation procedures have prompted stronger guidance from the AAP in conjunction with the American Academy of Pediatric Dentistry (AAPD).
Updated from 2016, the guidance recommends that at least two individuals with specific training and credentials should be present with a pediatric patient undergoing deep sedation/general anesthesia for dental treatment in a dental facility or hospital/surgicenter.
In either setting, an independent observer — with no additional responsibilities — must be skilled to assist with any medical emergency; both the independent observer and the operating dentist must be certified in Pediatric Advanced Life Support (PALS). The 2019 revision clarifies that the sedation must be administered by a qualified anesthesia provider (a medical anesthesiologist, certified registered nurse anesthetist, dentist anesthesiologist or second oral surgeon).
The clinical report, Guidelines for Monitoring and Management of Pediatric Patients Before, During and After Sedation for Diagnostic and Therapeutic Proceduresfrom theAAP and AAPD, replaces the “personnel” section (only) of the earlier version. That version called for the presence of one trained person with PALS certification to constantly observe the patient during deep sedation without the specification of an anesthesia-trained provider. The full 2019 report is available at https://doi.org/10.1542/peds.2019-1000 and will be published in the June issue of Pediatrics.
Dr. Coté is a lead author of the clinical report and a pediatrician and pediatric anesthesiologist who has been involved with all AAP sedation guidance since 1985.
