In the June issue of Pediatrics,1 the American Academy of Pediatrics (AAP) published a joint statement with the American Academy of Pediatric Dentistry updating the 2016 AAP sedation guideline.2 This statement contains strong wording concerning the need for an independent, skilled professional to manage children during deep sedation in the dental setting. It is essential for pediatricians and family practitioners to understand why this document was revised. The guideline reiterates the need for an appropriate history and physical examination, including a focused airway examination. For high-risk patients (eg, syndromic children or serious health issues), consultation with an anesthesiologist or other specialist is suggested. It provides a list of age-appropriate and size-appropriate equipment; resuscitation drugs and other sedation basics, including opioid and benzodiazepine antagonists; and decision algorithms for the management of airway obstruction, laryngospasm, and apnea. Oxygen saturation, expired carbon dioxide, heart rate, and other parameters are documented on a time-based record. Both the independent observer and the dental clinician must be up to date with Pediatric Advanced Life Support (PALS) or Advanced Pediatric Life Support certification.
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Coté CJ, Brown RE, Kaplan A. The Single-Clinician–Operator/Anesthetist Model for Dental Deep Sedation/Anesthesia: A Major Safety Issue for Children. JAMA Pediatr. Published online October 28, 2019. doi:https://doi.org/10.1001/jamapediatrics.2019.3823
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