Emergency management

Abstract

The pediatric dentist commonly provides minimal and moderate sedation in the offi ce-based setting. The proper management of sedation emergencies is critical to ensure the safety of the children for whom we care. The vast majority of sedation-related emergencies occur when intended moderate sedation progresses to deep sedation or general anesthesia. Due the variability in both pharmacodynamic and pharmacokinetic sedative drug effects, even the “standard dose” may turn out to be an overdose in a susceptible patient. Airway complications are the most likely sedation-related complications in healthy children. Airway obstruction from the tongue, a foreign body, laryngospasm, and bronchospasm are the most probable diagnoses. The ability to provide positive pressure oxygen, with or without an oropharyngeal airway, is the most critical skill needed to rescue children from sedation-related emergencies aside from recognition that a problem has actually occurred. An algorithm for managing these airway emergencies is provided.