Within the American Academy of Pediatrics, she is Chair of the Section on Anesthesiology and Pain Medicine.James Tom, DDS, MS is the current President of the American Society of Dentist Anesthesiologists and holds a full-time Associate Professor of Clinical Dentistry position at the Herman Ostrow School of Dentistry of USC.After you discuss the options for sedation and anesthesia with your child's dentist or oral surgeon, find out exactly who will be administering the medications and who will be watching your child during the dental procedure.Here's an overview of the various medical and dental professionals who may be involved in your child's dental procedure.The Association of Anaesthetists recommends that monitoring standards should be the same for sedation and anaesthesia: continuous ECG and pulse oximetry, some means of measuring respiration such as end tidal CO monitoring, frequent blood pressure estimations, and inspired oxygen concentration monitoring if the patient is breathing from a gas delivery system.1-7 The cost of anaesthetic equipment cannot be avoided if the children who failed to be sedated are dealt with on the same site.
The AAP and the AAPD recommend anesthesia professionals be with your child while the dentist or oral surgeon concentrates on the procedure.
General anaesthesia undoubtedly allows MRI to be carried out in anxious children, but sedation is sometimes seen as an acceptable alternative, particularly in the United States.
Conscious sedation is impractical in a noisy environment and deep sedation is necessary,1-1 1-2 in spite of official disapproval.1-3 Deep sedation usually involves a bolus of an oral hypnotic, which may need to be topped up with an intravenous tranquilliser or opioid.
The mortality from general anaesthesia alone is about 1 in 160 000 administrations,1-9 most perioperative deaths being caused by the patient's surgical condition.
The mortality from sedation is less certain as most prospective series are too small to produce reliable data.
Sedation is less predictable and it is accepted that there is a failure rate of between 5% and 15%.1-2 1-4-1-6 The induction of anaesthesia is relatively quick but sedation has a longer and more variable onset and offset1-5 during which the child must be observed.