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ADA House of Delegates adopts revisions in sedation, anesthesia guidelines

November 07, 2016

By Kimber Solana

Denver — The ADA House of Delegates voted Oct. 24 at its meeting to adopt revisions to the guidelines concerning the use of sedation and anesthesia by dentists and teaching sedation and anesthesia to dentists and dental students.

The revisions include recommended changes to 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 competency statements for moderate sedation education courses; and a number of editorial updates.

"Our main objective is always patient safety and these recommendations allow us to further these ideals," Dr. Dan Gesek, past-chair of the Council on Dental Education and Licensure, told ADA News after the meeting. "I applaud the Anesthesiology Committee for their diligent work on this document."

The approval comes a year after the 2015 House of Delegates voted to refer the proposed 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" — outlined in Resolution 77H-2015 — back to CDEL after a number of members raised concerns over the changes.
    
The 2015 House recommendations were:

  • Consider the 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.
  • Reconsider 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.
  • Make 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.
Regarding children, the revised ADA guidelines refer to use of the American Academy of Pediatrics/American Academy of Pediatric Dentistry's "Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures."

As with other health care organizations, the ADA publishes guidelines to assist dentists in the delivery of safe and effective care. The sedation and anesthesia guidelines were first adopted into policy by the ADA in 1971. State dental boards, when developing rules and statues on anesthesia in the dental office, may also use the guidelines.

"When state dental boards promulgate rules on anesthesia, many times the ADA guidelines are referenced," Dr. Gesek said. "Keeping our guidelines up-to-date is imperative for this reason alone."

This year, the council and its Anesthesiology Committee hosted hearings and accepted written and oral comments addressing the recommendations. The council then reported its conclusions and response, which the House adopted as Res. 37H-2016.

"The revisions to the guidelines are supported by evidence including systematic review of the benefits of monitoring end-tidal carbon dioxide in early identification of inadequate ventilation during moderate sedation," said Dr. David Sarrett, CDEL Anesthesiology Committee chair. The Science Institute prepared a report of the systemic reviews for CDEL; the Council on Scientific Affairs approved the report.

The systematic reviews contained evidence from over 4,000 patient sedation cases, he added. The CDEL Anesthesiology Committee also conducted a detailed review of all materials and comments received.

"These adopted guidelines now place the ADA as leaders in promoting safe sedation through updated recommended clinical guidelines and competency-based education and training," Dr. Sarrett said.

The guidelines were revised in 2012. To download the 2016 guidelines, go to ADA.org. Click on “Guidelines for the Use of Sedation and General Anesthesia by Dentists” and “Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students.”