Capnography Should Be Mandatory Monitoring For Moderate Sedation

Background There has been increasing concern by the American Dental Association, state dental boards, regional legislators, and specialty groups about the current state of dental anesthesia. Specific interest has surrounded methods to improve patient safety during parental sedation and anesthesia. Many times in the history of dental anesthesia, monitoring advances begin in the hospital for general anesthesia, then downscale, become smaller, and find utility in outpatient anesthesia. Monitoring advances ultimately have been shown to improve patient safety and are subsequently universally adopted. Practitioners should be aware that an anesthetic spectrum exists in parenteral sedation and anesthesia. For instance, there is data suggesting that a large number of patients planned for moderate sedation, may progress to deep sedation during which ventilation is impaired. With each individual patient responding differently to the administration of oral sedatives, intravenous anesthesia agents, or inhalational agents, anesthetics can have the effect of sedation, analgesia, hypertension, hypotension, combativeness, amnesia, apnea, or any one of many other more life-threatening events. It is incumbent upon all dental anesthesia providers to offer the highest spectrum of anesthesia monitoring and care currently available to prevent sedation effects from progressing to more serious situations. The most recent advance in anesthesia monitoring is capnography. It has been used in the operating room for many years to verify endotracheal tube placement. The capnogram provides information about respiratory rate and effectiveness, as well as end-tidal carbon dioxide values. Since 2011, the American Society of Anesthesiologists, and other prominent anesthesia organizations, have mandated capnography for use in moderate sedation. Most recently, the Oregon Board of Dentistry mandated capnography for all licensees performing moderate sedation effective Jan. 1, 2016. Capnography is also used in cardiopulmonary resuscitation and is advocated by the American Heart Association as an indicator of return of spontaneous circulation. Conclusions: Given the current regulatory environment concerning patient safety and monitoring during dental anesthesia, capnography should be a mandatory monitoring requirement for any dentist performing moderate sedation in the office. This instrumentation is easily added to any dental sedation monitoring armamentarium as a stand-alone unit or as a vital signs monitor upgrade and will demonstrate to the public and legislators that the dental profession is in alignment with monitoring recommendations of other anesthesia organizations.