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certain features that may limit its use in some patients and in certain clinical applications. Although this article focuses on the potent volatile agents, a brief description of nitrous oxide will be provided. Nitrous Oxide Of the common inhalational agents used in dentistry, nitrous oxide is the most utilized agent for most dental procedures and surgeries. With an extremely high MAC value (104%), nitrous oxide cannot be utilized as a general anesthetic alone. It is often coadministered with oxygen and the other volatile anesthetics. The gas

, limited cognitive functioning, physical disability, or medical conditions that require deep sedation or general anesthesia to complete dental treatment in a safe and humane fashion. 4 The dental profession has sought to continually develop and improve on previous safety standards in an effort to deliver safe and effective deep sedation and general anesthesia techniques. 5 The American Academy of Pediatric Dentistry (AAPD) endorses in-office use of deep sedation or general anesthesia administered by a trained, credentialed, and licensed pediatric dentist, dental or

after surgery. The only exception to this directive is for patients taking dabigatran with impaired creatinine clearance values (CrCl <50 mL/min). In this instance, preoperative holding intervals are usually doubled due to dabigatran's significant renal excretion ( Table 4 ). CONSIDERATIONS FOR DENTAL SEDATION AND GENERAL ANESTHESIA PROVIDERS With the increasing number of patients on OATs undergoing dental procedures, providers of sedation and general anesthesia for dentistry who encounter these patients should be comfortable

Knowledge of reversal agents, or pharmacologic antagonists, is essential for all providers of sedation and general anesthesia. Reversal agents are defined as any drug used to counter the pharmacologic effects of another drug. 1 This article reviews common reversal agents used in contemporary sedation and anesthesia practice for dentistry, specifically flumazenil, naloxone, neostigmine, sugammadex, and phentolamine, and discusses their use in emergency management and routine practice. This article also reviews safety considerations and

used for minimal and moderate enteral sedation in pediatric dentistry. Table 1. Common Pediatric Oral Sedation Medications Table 2. Antihistamine Adjuncts for Oral Sedation CHLORAL HYDRATE Chloral hydrate, a sedative-hypnotic aldehyde compound used in the late 1800s for insomnia, was once the predominant agent for oral sedation in children. Once absorbed by the gastrointestinal (GI) tract, chloral hydrate is metabolized by

% by FPS-R and 40% by PPPM and highest at 2 hours from discharge. This study identifies the high prevalence of postoperative pain in pediatric dentistry after GA and brings to the forefront the need for formalized assessment in the recovery period. In 1998, the World Health Organization named pain as the fifth vital sign, highlighting the importance of its assessment. 33 The early hours exhibit the most pain. Moderate-to-severe pain appears to peak at 2 hours, then reduces in intensity over the 3-day period, a trend which is consistent in morbidity studies

incidence of SMAS is 0.13 to 0.3%. 1 This case report outlines the anesthetic considerations and management of a patient with excessive supragastric belching and history of SMAS. CASE REPORT A 26-year-old female patient (weight 66 kg, height 155 cm), who presented with excessive supragastric belching, previously diagnosed with SMAS, was electively scheduled for general dentistry procedures including scaling, restorations, and extractions under intravenous deep sedation/nonintubated general anesthesia at a hospital outpatient ambulatory dental

With the recent increase in national attention directed at patient safety involving sedation and anesthesia for dentistry within the office-based environment, organizations inside and outside of dentistry are attempting to collect and evaluate data to improve outcomes and reduce or eliminate untoward events. However, given the general isolated nature of most dental practices, this has proved challenging. Unlike the hospital setting, which can provide abundant opportunity for licensed health care providers to practice in an environment prime

3. Unremarkable anteroposterior chest radiograph from 2015, which is typical of the disease. The patient also reported during the preoperative evaluation a previous general anesthetic for dentistry that was aborted when she experienced rapid desaturation/hypoxemia and required urgent intubation after intravenous induction of general anesthesia. This event reportedly happened at another dental office; however, those anesthetic records could not be obtained. No dentistry could be performed during that failed

, moderate sedation, deep sedation (DS), or general anesthesia (GA). There is a lack of recent data regarding morbidity and mortality events related to DS/GA for dentistry in Ontario, Canada's most populous province. Specifically, data are lacking for adverse events outside of hospital settings in terms of the number of deaths (mortalities) or severe injuries (morbidities) that occur in dental offices or surgicenters in relation to the number of DS/GAs provided in these ambulatory care settings. Morbidity and mortality reports are fundamental as they provide