Deep Sedation and GA

Abstract

The use of deep sedation and general anesthesia (DS/GA) to permit the completion of high-quality dental care for young children and patients with intellectual, emotional, or physical challenges is recognized as indispensable for a subset of these patients. The combination of behavioral techniques, minimal and moderate sedation, and even prolonged restraint, which some practitioners still provide, is not uniformly successful in achieving dental surgical goals. DS/GA can be safely provided in the dental office, ambulatory surgery center, or hospital provided that well-trained anesthesia providers are utilized. Airway management can include intubated, laryngeal mask airway (LMA) or natural airway techniques in any of these venues. Either dentist or physician anesthesiologists can be used; however, only dentist anesthesiologists have specific training requirements in office-based anesthesia management. In some states where it is legal, certified registered nurse anesthetists can also provide anesthesia in the dental office. It is critical for the pediatric dentist to understand what the pediatric anesthesia training is between these various providers and to ensure that emergency protocols are well thought out and prepared for by the anesthesia provider. Fortunately, the safety record of office-based anesthesia by well-trained dentist and physician anesthesiologists is exemplary allowing cost-effective care for these children with special needs.