IV and Oral Sedation
According to the American Society of Anesthesiologists (ASA), surgical procedures in doctors’ offices will reach 10 million by 2005, twice the number in 1995. In our office, surgical procedures are provided via local anesthesia or local anesthesia and conscious sedation. Conscious sedation is defined by the American Dental Association as “a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or non-pharmacological method or a combination thereof.”
The ADA also states that “patients subjected to parenteral conscious sedation must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (ASA I, II) this may be simply a review of their current medical history and medication use. However, with individuals who may not be medically stable or who have a significant health disability (ASA III, IV), consultation with their primary care physician or consulting medical specialist regarding potential procedure risk or special monitoring requirements may be desirable.”
According to the ASA, a pre-sedation assessment includes, but is not limited to:
- Physical status assessment (review of systems, vital signs, airway, cardiopulmonary reserve).
- Past and present drug history including drug allergies.
- Previous adverse experience with sedation and analgesia as well as with regional and general anesthesia.
- Results of relevant diagnostic studies.
- History of tobacco, alcohol, and substance use/abuse.
- Verification of patient NPO status.
- Plan and choice of sedation.
- Transportation arrangements for patients who are expected to be discharged from the facility.
To administer parenteral (e.g., intravenous) conscious sedation, it is advisable that a periodontist satisfy one of the following ADA criteria:
- Completion of a comprehensive training program in parenteral conscious sedation that satisfies the requirements described in Part I or Part III of the ADA Guidelines for Teaching Comprehensive Control of Pain and Anxiety in Dentistry at the time training was commenced.
- Completion of an ADA-accredited periodontal postdoctoral training program which affords comprehensive and appropriate training necessary to administer and manage parenteral conscious sedation.
Also, the following guidelines shall apply to the administration of parenteral conscious sedation in the periodontal office:
- Administration of parenteral conscious sedation by another duly qualified dentist or physician requires the operating periodontist and his/her clinical staff to maintain current expertise in basic life support (BLS).
- When a certified registered nurse anesthetist (CRNA) is permitted to function under the supervision of a periodontist, administration of parenteral conscious sedation by a CRNA shall require the operating periodontist to have completed training in parenteral conscious sedation, consistent with the standards of these guidelines.
- A periodontist administering parenteral conscious sedation, as well as his or her clinical staff, must document and maintain current expertise in basic life support (BLS). Advanced Cardiac Life Support (ACLS) or an appropriate equivalent is encouraged.