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.
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.
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:
|Antihistamine (e.g., diphenhydramine)||Face masks (p + a)*|
|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)*|
|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.|