Security is part of clinical risk management, which focuses on “improving the quality and safety of health services by identifying circumstances and opportunities that expose patients to risks of harm and acting to prevent or control them.”
Anesthesiology is considered a high-risk specialty because, due to the necessity of surgical interventions or procedures, it induces altered states of consciousness, removing the patient’s abilities such as regular breathing and normal functions of other organs, leading to physiological changes with potential dangers.
Beyond the irreplaceable role of specialized and trained professionals, utilizing standardized practices, technology, medications, and advanced equipment in appropriate facilities, it is possible to reduce the risk of adverse events, such as complications or errors that could compromise patients’ health.
Sedation, a topic discussed in other texts in this newsroom, involves the administration of one or more pharmacological agents, allowing the successful completion of diagnostic or therapeutic procedures, with the following objectives:
Reduce fear, anxiety, stress, pain, and discomfort;
Lower the level of consciousness and provide amnesia;
Maintain respiratory and cardiovascular stability;
Limit movement and control the patient’s behavior;
Minimize psychological trauma, ensuring a positive experience.
This population has an increased risk of sedation-related respiratory complications, which can lead to life-threatening conditions such as hypoxia, apnea, hypopnea, airway obstruction, laryngospasm, bronchospasm, and pulmonary aspiration. Therefore, the dental office environment should replicate, as closely as possible, the human and physical resources available in hospital settings.
To operationalize safety, the sedation process in a dental office setting unfolds in several phases:
Pre-Procedure Contact
Communication with parents or legal guardians via written and/or phone questionnaire to gather information—age, weight, height, medical history, surgical and anesthetic background, developmental and psychological history, and regular medications.
Providing information and addressing questions about sedation—benefits, risks, and limitations.
Day of the Procedure
In-person clinical evaluation and confirmation of fasting status.
Obtaining written informed consent.
Providing a safe and appropriate environment for pediatric care.
Monitoring respiratory and cardiovascular functions and inserting a peripheral venous catheter (usually in the hand or forearm).
Administration of sedative, anxiolytic, and amnesic medications.
Clinical record-keeping.
Awakening and post-sedation care—recovery, discharge criteria verification, and home care instructions.
Each phase is personalized, including the choice of sedation technique, tailored to the individual needs of each child or adolescent.
Their familiarity with the child or adolescent allows them to assist the clinical team in understanding emotions, reactions, and behaviors. Additionally, they provide comfort and emotional support, fostering trust and cooperation before and after sedation.
Considering all the above, the SedaCare team aims to provide children and adolescents with the most comfortable experience possible during oral rehabilitation, through practices based on clinical safety, which is essential for minimizing the risks of the procedures performed.
References:
World Health Organization, Topic 6 – Understanding and managing clinical risk, Patient Safety Curriculum Guide, [Internet]. Available from: https://cdn.who.int/media/docs/default-source/patient-safety/curriculum-guide/resources/ps-curr-teach-guides/topic-06_understanding-and-managing-clinical-risk_teaching-slides.pdf?sfvrsn=f4469_9
Zielinska M, Bartkowska‐Sniatkowska A, Becke K, et al. Safe pediatric procedural sedation and analgesia by anesthesiologists for elective procedures: A clinical practice statement from the European Society for Paediatric Anaesthesiology. Pediatric Anesthesia. 2019;29:583–590.
South African Society of Anaesthesiologists. SASA paediatric guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children: 2021–2026 [Internet]. 2022. Available from: https://journals.co.za/doi/epdf/10.36303/SAJAA.2021.27.4.S2.2635
Green SM, Irwin MG, Mason KP, on behalf of the International Committee for the Advancement of Procedural Sedation. Procedural sedation: providing the missing definition. Anaesthesia. 2021;76(5):598-601. https://doi.org/10.1111/anae.15213.
Jang YE, Kim JT. Effective and safe pediatric sedation. Anesth Pain Med 2024;19(Suppl 1):S36-S48 https://doi.org/10.17085/apm.24046
Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatr Dent. (2019) 41:259–60.
Gao F, Wu Y. Procedural sedation in pediatric dentistry: a narrative review. Med. (2023)10:1186823. doi: 10.3389/fmed.2023.1186823
Abrunhosa M, Alves A, Alves C, Amadeu M, et al. Manual de Anestesiologia. 1ª ed. Machado H, coordenador. Lidel; 2013.