Would love to know what monitors, equipment, and medications are available in these settings. Also curious of the dose and type of local used.
Agreed. Lots of information not known. Sometimes these places just use nitrous as sedation with no IV. Did this kid spasm and they couldn’t ventilate, goes hypoxic, arrests then can’t give epi because no IV and didn’t have the presence of mind to give IM? Was it gas inhalation then IV sedation? Did they have paralytics? Monitors?
From their website…..
“Pediatric
Goal
To allow your child’s dental procedure to be accomplished, in an office setting, safely and comfortably.
Methods
An intravenous (i.v.) catheter is started and connected to tubing and i.v. fluid. In most cases we will ask one of the parents to sit in the dental chair with the child on their lap. The parent will help keep the child looking away from the anesthetist (often with the help of another family member) while the i.v. is started. Your child will experience only a slight sting. Typical reactions range from mild suprise to a little crying. Medications can then be swiftly given to have the child sleeping within seconds.
In children who are unable to tolerate this, we will administer an intramuscular injection of medications (see below) which will allow us to place an i.v. without them being aware of it. We will ask the child to give the parent a ‘big bear hug”, and the parent should hug the child tightly, keeping their arms clear of the upper part of the buttocks. The injection will be administered quickly. The medication does not sting and the reactions of children can vary greatly. Many children don’t cry, some cry mildly, and some respond vigorously. Within several minutes the child will be unaware of his/her surroundings and an i.v. can be safely placed. Occasionally, a parent will prefer to tell the child that they will be getting a shot. We will be happy to do this, but our experience leads us to favor the surprise approach, as the child doesn’t become apprehensive and doesn’t tighten muscles prior to the injection.
After the i.v. is placed, it will be used to administer sedative drugs and any additional drugs which may be necessary. It also provides access in the unlikely event that emergency drugs need to be administered. Parents are allowed back in the sedation room while sedation is initiated but then will be asked to return to the waiting area during the procedure.
Medications
Intramuscular Ketalar (ketamine) and Versed (midazolam) may be used if the patient is uncooperative. This combination of drugs works quickly and the child will become unresponsive within several minutes. They will typically stare blankly and become flaccid. They may also drool and become teary-eyed. These are normal responses to the medication and are not cause for alarm.
I.V. medication is typically composed of an amnestic/hypnotic called Diprivan (propofol). This is given according to the patient’s weight and is administered by an infusion pump, which can be adjusted on a moment-to-moment basis. These drugs are very short acting and, therefore, wear off very quickly. Supplemental oxygen is usually given as well.
Dental restoration carries a high incidence of post-operative nausea and vomiting (PONV). For this reason, anti-nausea drugs are given through the i.v. in all cases as a preventative measure. The overall occurrence of PONV with our protocol is extremely low. When it occurs, it is usually self-limiting – meaning vomiting may occur once or twice, and the nausea subsides. Unchecked vomiting in a child can be a very serious problem. If your child experiences PONV at home which lasts for more than two hours, notify your dentist, who will prescribe an anti-nausea suppository.
Monitoring
An EKG monitors the heart rhythm. A pulse oximeter monitors blood oxygen levels. Respiration is monitored by capnography and direct observation. An automatic blood pressure monitor is also used. Close observation is employed.
Recovery and Post-op
Patients are usually ready to leave the office within one hour of the conclusion of the procedure. They will be able to sit without any undesirable symptoms, their vital signs will be stable, they will be responding in an appropriate fashion, and will display appropriate , but diminished, physical coordination. Children are discharged when still somewhat drowsy and will usually require carrying. They must have adult supervision for the remainder of the day and should not be allowed to participate in any activities in which lack of coordination or alertness would endanger them.”
