Fasting and Aspiration Risk in Procedural Sedation

Author(s):  
Maala Bhatt ◽  
Mark G. Roback

There is a documented increase in the risk of aspiration of stomach contents during airway management for general anesthesia. This risk of a serious complication has resulted in strict regulatory recommendations concerning preprocedural fasting even for moderate and deep sedation. The physiology and evidence for fasting recommendations before procedural sedation care in children are discussed here.

Author(s):  
Élise W. van der Jagt

When patients undergo procedural sedation/analgesia, they enter into a sedation continuum. Several levels have been formally defined along this continuum: minimal sedation/anxiolysis, moderate sedation, deep sedation, and at the deepest level, general anesthesia. An additional and somewhat separate level in the sedation continuum is dissociative sedation, which has its own unique characteristics. Given the dynamic nature of the sedation process, a patient will move in and out of these defined levels (as well as intermediate ones) depending on the agents and dosing used, the procedures being performed, and a patient’s own unique characteristics and physiologic responses. At all times, the provider of procedural sedation/analgesia must be able to recognize the sedation levels attained by the patient and be ready to manage any potential adverse events.


2021 ◽  
Vol 9 ◽  
pp. 2050313X2110145
Author(s):  
Chaerim Oh ◽  
Hyun Joo Kim

In patients with intratracheal tumors, airway management while maintaining oxygenation and providing surgical access to the airway can be challenging. Here, we present a case of a two-stage operation to remove an intratracheal tumor causing partial obstruction near the carina. In the otorhinolaryngology department, a biopsy was performed during apnea under high-flow nasal oxygenation support. A few days later, a thoracic surgeon performed tracheal resection after sternotomy under general anesthesia. Mechanical ventilation was performed by inserting a sterile endotracheal tube in the resected distal part of the trachea in the surgical field for tracheal end-to-end anastomosis. Airway was successfully secured through close communication between teams of anesthesiologists and surgeons.


2014 ◽  
Vol 118 (3) ◽  
pp. 569-579 ◽  
Author(s):  
M. Ramez Salem ◽  
Arjang Khorasani ◽  
Siavosh Saatee ◽  
George J. Crystal ◽  
Mohammad El-Orbany

2012 ◽  
Vol 27 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Sung-Jin Hong ◽  
Yoo-Jin Kang ◽  
Young-Hun Jeon ◽  
Ji-Seon Son ◽  
Jang-Ho Song ◽  
...  

2014 ◽  
Vol 61 (4) ◽  
pp. 171-179 ◽  
Author(s):  
Daniel E. Becker

Abstract The risk for complications while providing dental procedures is greatest when caring for patients having significant medical compromise. It is comforting that significant adverse events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, the office team must be prepared to manage untoward events should they arise. This continuing education article will address basic emergency drugs that should be available in all dental practices and additional agents that become essential for those practices providing various levels of procedural sedation or general anesthesia.


2021 ◽  
Vol 9 ◽  
Author(s):  
Avia Fux-Noy ◽  
Luna Mattar ◽  
Aviv Shmueli ◽  
Elinor Halperson ◽  
Diana Ram ◽  
...  

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it.Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period.Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.


2005 ◽  
Vol 63 (2) ◽  
pp. 163-172 ◽  
Author(s):  
Timothy T. Coyle ◽  
John F. Helfrick ◽  
Martin L. Gonzalez ◽  
Randi V. Andresen ◽  
David H. Perrott

2010 ◽  
Vol 2010 ◽  
pp. 1-16 ◽  
Author(s):  
Piet L. J. M. Leroy ◽  
Daphne M. Schipper ◽  
Hans (J.) T. A. Knape

Objectives. To investigate which skills and competence are imperative to assure optimal effectiveness and safety of procedural sedation (PS) in children and to analyze the underlying levels of evidence.Study Design and methods. Systematic review of literature published between 1993 and March 2009. Selected papers were classified according to their methodological quality and summarized in evidence-based conclusions. Next, conclusions were used to formulate recommendations.Results. Although the safety profiles vary among PS drugs, the possibility of potentially serious adverse events and the predictability of depth and duration of sedation define the imperative skills and competence necessary for a timely recognition and appropriate management. The level of effectiveness is mainly determined by the ability to apply titratable PS, including deep sedation using short-acting anesthetics for invasive procedures and nitrous oxide for minor painful procedures, and the implementation of non-pharmacological techniques.Conclusions. PS related safety and effectiveness are determined by the circumstances and professional skills rather than by specific pharmacologic characteristics. Evidence based recommendations regarding necessary skills and competence should be used to set up training programs and to define which professionals can and cannot be credentialed for PS in children.


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