Concerns Regarding the Single Operator Model of Sedation in Young Children.

Abstract

* Abbreviations: AAP — : American Academy of Pediatrics AAPD — : American Academy of Pediatric Dentistry AAP-CA — : American Academy of Pediatrics, California ASA — : American Society of Anesthesiologists PALS — : pediatric advanced life support In July 2016, the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) released their joint updated “Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures.”1 The purpose of this update, as stated by the authors and supported by the AAP and AAPD, was to “unify the guidelines for sedation used by medical and dental practitioners; to add clarifications regarding monitoring modalities…; to provide updated information from the medical and dental literature; and to suggest methods for further improvement in safety and outcomes.” They described the substantial differences between sedation for children and adults, and emphasized the subtlety and rapidity with which young children can pass from 1 level of sedation to another unintended level. The need to have practitioners that can quickly recognize the signs of deeper levels of sedation and have the skills, equipment, and support personnel to rescue the child from potential adverse responses to these unintended levels of sedation is critical. My nephew Caleb was a strong, healthy, 6-and-a-half year old when he died. Caleb was scheduled to have a mesiodens tooth extracted, a supernumerary tooth between the 2 central incisors. His oral surgeon had recommended general anesthesia. Caleb’s parents did not consent lightly to … Address correspondence to Rita Agarwal, MD, Department of Anesthesiology, Perioperative Medicine and Pain Management, Stanford University Hospital, 300 Pasteur Dr, Stanford, CA 94305. E-mail: agarwalr{at}stanford.edu