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American Academy of Pediatrics updates sedation guidelines

WASHINGTON, U.S.: The death of a 4-year-old boy while under sedation at an Oklahoma dental office last month has brought into question the guidelines around pediatric anesthesia. In response to the tragedy, the American Academy of Pediatrics has updated its guidance on sedation for dental procedures in children and, in conjunction with the American Academy of Pediatric Dentistry, has written a clinical report.

The 2019 guidelines stipulate that at least two people with specific training and credentials, as detailed in the report, should be present with a pediatric patient undergoing deep sedation or general anesthesia for dental treatment in a dental facility or hospital. The update also clarifies that the sedation should be administered by a qualified anesthesia provider. The guidelines now define the role of a qualified anesthesia provider, who may be a medical anesthesiologist, certified registered nurse anesthetist, dentist anesthesiologist or second oral surgeon, among others.

“Sedation for dental procedures in children and teenagers is generally safe,” said lead author of the clinical report Dr. Charles J. Coté, who is a pediatrician and a pediatric anesthesiologist. “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.”

According to the 2019 guidelines, one of the two trained people required for sedation must be an independent observer who is not involved with performing or assisting with the dental procedure. This person’s sole responsibility is to constantly observe the patient’s vital signs, and he or she must possess the necessary skills to assist with any medical emergency. Both the independent observer and the operating dentist must be certified in pediatric advanced life support.

The report, titled “Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures,” was published in the June 2019 issue of Pediatrics.

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