Guidelines for the Use of Parenteral Sedation: University of Southern California School of Dentistry

appendix Guidelines for the Use of Parenteral Sedation: University of Southern California School of Dentistry

This protocol was developed to provide guidelines for the safe and effective use of parenteral (intramuscular [IM] and intravenous [IV]) sedation procedures in the clinical environment. They are meant to be guidelines, flexible and dictated by the requirements of the specific clinical situation. In addition, these guidelines will require periodic revision as newer developments arise in the area of parenteral sedation.

PRELIMINARY EVALUATION

Candidates for parenteral sedation must be fully evaluated before the procedure to determine their physical status and need for sedation.

1. An approved medical history must be completed, must be dated, and must contain all indicated signatures.
2. Parenteral sedation is not contraindicated for use in the American Society of Anesthesiologists (ASA) 1 and 2 patient.
3. Parenteral sedation may be used in selected ASA 3 patients following evaluation and consent from the supervising faculty.

Appropriate written informed consent (or special behavior management consent form) must be obtained from the patient, parent, or guardian of the patient before the procedure. The medical history and planned sedation must be reviewed by the responsible faculty person and students.

Pretreatment instructions will be explained and a written form given to the patient, parent, or guardian of the patient. A sample of these instructions is provided later in this appendix (see Addendum A).

Before each treatment appointment, the medical history database is updated as necessary. Minimum questioning includes “Has there been any change in your medical history, health, or medicines since your last appointment?” All responses, positive and negative, are noted in a dated, signed treatment note. Minimum preoperative vital signs consisting of blood pressure and heart rate/rhythm must be measured at each treatment appointment and noted in the records.

It is understood that with some patients being discussed in this protocol, it may prove to be impossible to obtain preoperative vital signs. In such cases vital signs are monitored immediately upon induction of sedation.

MONITORING

All patients receiving parenteral sedation are monitored by direct observation (e.g., skin, mucous membrane color, respiratory movements). In addition, the following continuous monitoring must be employed:

• Pulse oximetry and/or capnography

and

• Pretracheal stethoscope

and

• Automatic vital signs monitor (every 5 minutes)

• Blood pressure
• Heart rate
• Also the following when indicated:

Electrocardioscope
Capnograph

If an automatic vital signs monitor is not available, manual monitoring is performed every 5 minutes.

The information obtained must be recorded onto a suitable anesthesia/sedation record at appropriate intervals (every 5 to 15 minutes).

EMERGENCY DRUGS AND EQUIPMENT

In all parenteral sedation procedures, emergency equipment and drugs must be available. The following is included (as a minimum):

Emergency Drugs Equipment
Epinephrine Positive-pressure O2
Antihistamine (e.g., diphenhydramine) Face masks (p + a)*
Ephedrine Laryngoscope
Anticonvulsant (e.g., midazolam) Endotracheal tubes (p + a)*
Corticosteroid (e.g., hydrocortisone) Lubricant jelly Suction tips
Vasodilator (e.g., nitroglycerin) Oropharyngeal airways (p + a)*
Drug for emergence delirium (physostigmine) Defibrillator
Narcotic antagonist (e.g., naloxone) Blood pressure cuff (p + a + t)*
Hydralazine (Diazoxide) Stethoscope
Bronchodilator (albuterol—as an inhaler) Nasopharyngeal airways (p + a)*
(Epinephrine, aminophylline, Isuprel—IV drugs) Magill forceps
Emergency equipment must be located either in the operatory or adjacent to the treatment area. Emergency procedure protocols should be available and monitored periodically.

* a, Adult; p, pediatric; t, thigh.

TECHNIQUE

Preliminary Appointment

Evaluation of the following:

1. Need for parenteral sedation
2. Medical history obtained and reviewed
3. Dental treatment plan, if possible
4. Selection of IV/IM procedure
5. Check for presence of superficial veins (if IV procedure to be used)
6. Obtain baseline vital signs, if possible
7. Preoperative instructions to patient, parent/guardian (see Addendum A)
8. Patient education, as possible
9. Informed consent signed
10. Medical consultation, medically compromised patients at least annually; biannually for all other candidates for parenteral sedation or at discretion of supervising faculty

Day of Treatment

The treatment team will consist of the following (minimal) personnel:

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IV Sedation Special Pediatric

Related posts:

  1. 19: Teaching Inhalation Sedation: History and Present Guidelines
  2. 36: The Geriatric Patient
  3. 39: Neurologic Illnesses and Other Conditions
  4. 16: Inhalation Sedation: Complications
  5. 15: Inhalation Sedation: Techniques of Administration
  6. 6: Nondrug Techniques: Iatrosedation and Hypnosis

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Jan 5, 2015 | Posted by in General Dentistry | Comments Off on Guidelines for the Use of Parenteral Sedation: University of Southern California School of Dentistry

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