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Further consideration sought on proposed sedation, anesthesia guideline revisions

November 19, 2015

By Kimber Solana


Town hall: (From left) Dr. Jim Boyle, then-Council on Dental Education and Licensure chair; Dr. Dan Gesek, current CDEL chair; and Dr. Prabu Raman, CDEL member, listen during a town hall meeting held at ADA 2015 to discuss proposed revisions to the ADA's anesthesia guidelines.
In seeking additional changes on proposed revisions to the guidelines concerning the use and teaching of sedation and anesthesia, the 2015 House of Delegates voted in November to refer the proposed guidelines back to the Council on Dental Education and Licensure.

The council and its Committee on Anesthesiology had sought revisions to the "ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists" and the "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students."

"This was a normal review to make sure our guidelines are current and ensure the safety of our patients," said Dr. Dan Gesek, CDEL chair.

The proposed revisions to both documents recommended revisions to anxiolysis and sedation statements regarding children age 12 and under; end-tidal CO2 monitoring during moderate and deep sedation and general anesthesia unless precluded or invalidated by the nature of the patient, procedure or equipment; alterations in course duration and other educational requirements for moderate sedation competency courses; and a number of editorial updates.

The council and its Anesthesiology Committee had agreed on the proposed changes; the council unanimously supported transmittal of Resolution 77 calling for adoption of the proposed guidelines to the House of Delegates. However, Dr. Gesek said, there were a few organizations and a number of members who had raised concerns over the changes.

"The House took the appropriate action ensuring that its members will be properly informed on the guideline changes in 2016," Dr. Gesek said.

The House at its Washington, D.C. meeting referred the proposed guidelines back to CDEL, in collaboration with the Council on Scientific Affairs, with recommendations to consider.

The House recommendations are:

  • Elimination of the mandate for monitoring end tidal CO2 for moderate sedation to allow for the choice of options such as: continuous use of a precordial or pretracheal stethoscope, continuous monitoring of end tidal carbon dioxide, and continual verbal communication with the patient.
  • Reconsideration of the section "Moderate Sedation Course Duration" (hours and content), as proposed by level of sedation, or a possible option of separate course requirements for enteral and parenteral routes of sedation.
  • Making patient evaluation provisions consistent throughout the document, including but not limited to, rationale and guidelines for the use of body mass index  and the timing of medical history review.
The council will consider the Anesthesiology Committee's recommendations in the spring and report its conclusions and recommendations to the 2016 ADA House of Delegates in the fall.
 
The guidelines were last revised in 2012.

For more information on the current and proposed ADA anesthesia guidelines or go to ADA.org or email Jane Jasek at jasekj@ada.org.