The 2010 House of Delegates of the American Society of Anesthesiologists (ASA) amended its Standards for Basic Anesthetic Monitoring to include mandatory exhaled end-tidal carbon dioxide (E_tCO₂) monitoring during both moderate and deep sedation to its existing requirement for endotracheal and laryngeal mask airway general anesthesia. It became effective as of July 2011 and now reads:

“During regional anesthesia (with no sedation) or local anesthesia (with no sedation), the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs. During moderate or deep sedation, the adequacy of ventilation shall be evaluated by continual

Abstract

The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels (≥94%) be consistently maintained by a single operator/sedationist? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification (I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia.

Abstract

Nasal foreign bodies may result from the abundant availability of tiny objects in our society and a curious child exploring his or her nasal cavities. An inserted object that is not witnessed or retrieved can remain relatively asymptomatic or cause local tissue damage and potentially yield more serious consequences. An unusual case of a young child who presented for dental rehabilitation under general anesthesia is described. Immediately prior to the nasotracheal intubation, an unanticipated foreign body was detected and safely removed before any injury occurred. This case report discusses the presentation and pathophysiology of nasal foreign bodies. Moreover, applicable suggestions are provided to aid in the prevention and management of the unexpected discovery of a nasal foreign body after the induction of general anesthesia.

Abstract

The risk for cardiovascular complications while providing any level of sedation or general anesthesia is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, providers must be prepared to manage untoward events should they arise. This continuing education article will review cardiovascular complications and address their appropriate management.

Asako Yasuda ,

^a Department of Dental Anesthesiology, The Nippon Dental University, School of Life Dentistry at Tokyo; *Section of Radioisotope Research, Research Center for Odontology, The Nippon Dental University, School of Life Dentistry at Tokyo

Mikiko Yamashiro ,

Shuichi Hashimoto ,

The Latest ASA Mandate: CO₂ Monitoring For Moderate and Deep Sedation

Analysis of Oxygen Saturations Recorded During Dental Intravenous Sedations: A Retrospective Quality Assurance of 3500 Cases

Abstract

Nasal Foreign Body: An Unexpected Discovery

Abstract

Modified i-gel Airway for Oral Surgery

Recognition and Management of Complications During Moderate and Deep Sedation. Part 2: Cardiovascular Considerations

Abstract

Continuing Education Program

JSDA Abstracts

The Latest ASA Mandate: CO₂ Monitoring For Moderate and Deep Sedation

Analysis of Oxygen Saturations Recorded During Dental Intravenous Sedations: A Retrospective Quality Assurance of 3500 Cases

Nasal Foreign Body: An Unexpected Discovery

Modified i-gel Airway for Oral Surgery

Recognition and Management of Complications During Moderate and Deep Sedation. Part 2: Cardiovascular Considerations