Various supraglottic airways can also be utilized in unconscious patients as advanced airway adjuncts and are indicated when BVM and the insertion of an oropharyngeal airway do not overcome soft tissue airway obstruction or the pressure needed to generate an adequate tidal volume is too high, such that gastric insufflation is likely. A supraglottic airway is generally easy to insert and provides a conduit for air directly to the glottic area. There are many to choose from and one commonly used type is the laryngeal mask of which various brands and designs are available. Of the laryngeal masks, the i-Gel brand does not require cuff inflation, has venting for gastric air, and does not fold at the tip. Therefore, the i-Gel may reduce tasks and ease placement such that PPV can be more rapidly provided in an emergency. Placement is generally uncomplicated, but repeated training in its use is required (Fig. 13.3). Another supraglottic airway, the King LTD, is one version of a supraglottic airway that enters the esophagus with inflatable cuffs that seal the esophagus and oropharynx. Fenestrations between the cuffs allow an attached BVM to provide ventilation to the glottis (Fig. 13.4). Although endotracheal intubation is the gold standard for securing the airway, endotracheal tube insertion is generally not in the skill set of the pediatric dentist (Fig. 13.5).

The AAPD recommends drugs and equipment that should be available in pediatric dental offices for both medical- and sedation-related emergencies. Significant latitude is allowed for individual practitioners, however. Tables 13.1, 13.2, and 13.3 list recommended AAPD medical emergency drugs as well as sedation emergency drugs and equipment listed in the 2007 Joint American Academy of Pediatrics (AAP)/AAPD Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures [9] that can be modified based on provider training, skill, and practice. According to the Joint Guidelines, “The choice of emergency equipment may vary according to individual or procedural needs.” Therefore, Tables 13.4, 13.5, and 13.6 list what the author considers a focused and practical medical and sedation emergency kit for the pediatric dentist providing office-based oral moderate sedation based on current training standards. All of these drugs and devices may not be discussed in this chapter so the pediatric dentist is encouraged to review these tables carefully.