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ADA Updates Guidelines to Protect Patients Under Sedation by Geoffrey Archibald, DDS


hen new patients come into my office, I always ask if they have been diagnosed with sleep apnea. It’s an important piece of their medical history that I need to know before I begin sedation. If a patient has been diagnosed with sleep apnea, I will treat him or her differently and monitor them more closely. A few years ago, a patient said no when I asked her this question. I gave her our initial dose of anesthesia, and she completely stopped breathing. My assistant and I followed protocol, taking steps to get her breathing again. We were just about to get the reversal agents when the woman opened her eyes, took a nice, deep breath and said, “I am so relaxed.” It’s a good thing she was relaxed, because I definitely was not! It turns out that patient was later diagnosed with sleep apnea. Situations like these are rare; however, they can have drastic outcomes. Patients with breathing problems,

50 DSP | Spring 2017

like sleep apnea or asthma, are some of the most likely to stop breathing under anesthesia. With an estimated 22 million Americans¹ suffering from sleep apnea, and as many as 80% of those cases undiagnosed, it’s imperative that sedation dentists are aware of the risks. At the time that patient stopped breathing in the chair, I was not using a carbon dioxide monitor in my practice. I have since started using an end-tidal CO2 monitor, called a capnograph, as an extra line of defense in protecting my patients. Capnographs send an alert the instant a patient stops breathing; however, they are not widely used in general dentist’s office. That may start changing, as the American Dental Association adopted guidelines in October 2016 recommending all dentists – not just oral surgeons – apply capnography during sedation procedures. Most general dentists use pulse oximetry, which measures the amount of oxygen in the blood. A patient would have to hold his or

Dental Sleep Practice 2017 Spring  
Dental Sleep Practice 2017 Spring