Pediatric Dental Sedation Documentation: Essential Records for Safe Patient Care

Documentation covers different parts of the procedure, it includes documents before sedation (Diagnosis appointment), immediately before sedation (Sedation appointment), during sedation (monitoring), after sedation and Discharge questionnaire (SASA, 2020).

Documentation Before Sedation

Medical history questionnaire should be completed in the first appointment and authorized by the child’s parent or guardian (SASA, 2020).

Informed Consent

This document must be in verbal and written format, signed before administration of any sedative or analgesic drug (AAPD, 2019), it consists of cost, explanation of the dental procedure, intended sedation medication, administration route, risks and benefits and lastly, any other appropriate alternatives (SASA, 2020).

Pre-Sedation Instructions

Pre sedation instructions must be clearly explained to the parent before the day of the procedure some of the instructions include; child should wear comfortable loose clothes (AAPD, 2019), child taking chronic disease medication must take it on the day of the procedure with small sips of clear fluid, after discussing this with the doctor or dentist (SASA, 2020). Make sure that the child doesn’t wear nail polish (Çiçek et al., 2011), it was shown that nail polish may interfere with the pulse oximetry measurements (Çiçek et al., 2011).

Fasting Rule

Poor protective reflexes during sedation can lead to pulmonary aspiration (Mallory et al., 2011), that’s why fasting is recommended before sedation for; Formula milk or Solid food: six hours, Breast Milk: four hours and Clear fluids: two hours (SASA, 2020).

In case of emergency and the patient has not fasted, the risk is clearly balanced with the urgency of the treatment and risk of delaying of procedure (Treston, 2004).

Post-Sedation Instructions

Given to the parent in verbal and written format can include but not limited to; Avoid lip bitting due to paresthesia by local anesthesia injection (SASA, 2020), monitor the child for atleast 12 hours after the procedure without interfering with their activities if they need to rest quietly (SASA, 2020), introduce food slowly by starting with fluids then move to solids (SASA, 2020).

Documentation Immediately Before Sedation

Pre-procedural checklist must be completed to minimize adverse effects of the procedure (SASA, 2020), in addition, measurements of the vital signs is taken and compared with the baseline measurements taken during history (AAPD, 2019), any changes must be recorded (SASA, 2020).

Documentation During Sedation: Monitoring

This include a time-Based document which should be updated at least every 10 minutes (SASA, 2020). Route and dose of sedation medication are recorded first, monitoring depth of sedation, airway patency, adverse events and complications must be then reported (SASA, 2020); (AAPD, 2019). Behaviour monitoring can also provide a helpful tool to determine the depth of the sedation (SASA, 2020).

According to SASA the University of Michigan Sedation Scale (UMSS) is an easy, effective and credible scale that facilitates fast and reliable assessment of depth of sedation in children (SASA, 2020); (Malviya et al., 2002).

Documentation After Sedation: Recovery and Discharge

Following the sedation procedure, the child needs to be observed in an adequately equipped recovery room (Hosey, 2002). Observation must be done by a health professional trained with BLS (SASA, 2020) till there is no further risk of reduction in consciousness of the patient (AAPD, 2019).

To discharge the patient from the medical facility, this necessitates that the patient has no pain, is easily rousable, can take oral fluid, can talk & sit unaided and most importantly with a patent and uncompromised airway (SASA, 2020).

References

• Hosey, M.T., 2002. UK national clinical guidelines in paediatric dentistry. Int J Paediatr Dent, 12, pp.359-372.

• Mallory, M.D., Baxter, A.L., Yanosky, D.J., Cravero, J.P. and Pediatric Sedation Research Consortium, 2011. Emergency physician–administered propofol sedation: a report on 25,433 sedations from the pediatric sedation research consortium. Annals of emergency medicine, 57(5), pp.462-468.

• Treston, G., 2004. Prolonged pre‐procedure fasting time is unnecessary when using titrated intravenous ketamine for paediatric procedural sedation. Emergency Medicine, 16(2), pp.145-150.