Patient Safety During Sedation

Dr Gary Winter

In the interest of safer practices there are new regulations relating to both oral and intravenous conscious sedation. Any dental practitioner not following the new regulations is both breaking the law and putting patients at a greater risk of an emergency health crisis.

Prior to October 1st 2019 all general dentists were qualified to administer oral conscious sedation and with the appropriate qualifications to administer intravenous conscious sedation with patient monitoring carried out by basic pulse oximetry.

Pulse oximetry is the measurement of the percentage of oxygen in ones blood usually measured by a monitor on a fingernail using colorimetry. Some monitors also measure heart rate.

If a patient experiences a bad reaction or a medical crisis during a procedure carried out under conscious sedation, the sedation affect can be reversed by intravenous administration of a medication that allows the patient to regain full consciousness from the sedation effect immediately and allows the sedationist to manage other medical issues there may be.

Oximetry has its limitations with the most significant being the time delay for the oximeter to measure change in oxygen saturation by possibly 2-3 minutes. This in effect can mean that a patient may be well into respiratory crisis before it is diagnosed. These limitations have prompted the new regulations to be introduced. This involves an additional method to monitor a patients vital signs when sedated and also extra qualifications for the sedationist and the dental assistant to be allowed to perform and monitor a consciously sedated patient.

Along with oximetry and blood pressure measurement capnography has been introduced.

All the measurements are carried out on one monitor. Capnography measures the amount of carbon dioxide we breathe out and is measured by two sensor prongs that rest beneath the nostrils. Capnography is so sensitive that it measures with the accuracy every breath we take which means if sedated patients have a respiratory crisis the monitoring dental assistant and the sedationist are aware and can respond to the situation within seconds.

This is a huge step forward in patient safety and better practices.

At my Practice, Dental on Raffles conscious sedation has been a very large part of the service we provide for our patients and from referring practices. We have my experience of carrying out conscious sedation for 40 years and assisted by young up and coming sedationist Tabetha Lindsay along with two dental assistants qualified in sedation monitoring. We believe we are as well prepared to manage conscious sedation expertly.

As a Practice we recently spent a full day being educated on advanced respiratory support and medical emergencies.

At Dental on Raffles patient safety is paramount for all treatments we carry out. When one is sedated your wellbeing and comfort may be beyond your control and you rely on the expertise of those looking after you. We feel we are doing all within our power to deliver the safest practices possible.

For further information contact Dental on Raffles, Napier.

Gary Winter BDS
Principal Dentist