1. Pre-treatment, Day of treatment and Post op
Sedation

2. Sedation Medications NOCTEC: VISTARIL: DEMEROL: VERSED: VALIUM:
Chloral Hydrate, comes in capsule and syrup form
1 tsp = 500mg
Effective sedation and hypnotic
Had tendency to cause gastric irritation – nausea and vomiting
Should not be used in patients with liver or renal impairment or heart disease
VISTARIL:
Hydoxyzine pamoate, skeletal muscle relaxant
1 tsp = 25mg
Effective in minutes
Used for systemic relief of anxiety and tension
DEMEROL:
Hydrochlorate, analgesia and sedation
1 tsp = 50mg
For relief of moderate to severe pain
Support analgesia
VERSED:
Midazolam, like Valium
Causes relaxation and light sedation; it also causes amnesia
It can be taken alone or with Vistaril
VALIUM:
Diazepan, has a calming effect – relief of anxiety
Should not be used with patients that are on anticonvulsants
PHENERGAN:
Antihistamine, anti-nausea and sedation
Prevents and controls nausea and vomiting associated with anesthesia and surgery
Helps to control postoperative pain
Sedative—helps to relieve apprehension and sometimes induces light sleep
Sedation Medications

3. Preparing for your child’s sedation visit
We have recommended sedation for your child’s safety and comfort during dental procedures. Sedation can help increase cooperation and reduce anxiety and/or discomfort associated with dental treatment. Various medications can be used to sedate a child; medicines will be selected based upon your child’s overall health, level of anxiety, and dental treatment recommendations. Once the medications have been administered, it may take up to an hour before your child shows signs of sedation and is ready for dental treatment. Most children become relaxed and/or drowsy and may drift into a light sleep from which they can be aroused easily. Unlike general anesthesia, sedation is not intended to make a patient unconscious or unresponsive. Some children may not experience relaxation but an opposite reaction such as agitation or crying. These also are common responses to the medicines and may prevent us from completing the dental procedures. In any case, our staff will observe your child’s response to the medications and provide assistance as needed.
You, as parent/legal guardian, play a key role in your child’s dental care. Children often perceive a parent’s anxiety which makes them more fearful. They tolerate procedures best when their parents understand what to expect and prepare them for the experience. If you have any questions about the sedation process, please ask. As you become more confident, so will your child.
Prior to your child’s sedation appointment:
Please notify our office of any change in your child’s health and/or medical condition. Fever, ear infection, nasal or chest congestion, or recent head trauma could place your child at increased risk for complications. Should your child become ill just prior to a sedation appointment, contact our office to see if it is necessary to postpone the sedation.
Tell us about any prescribed, over-the-counter, or herbal medications your child is taking. Check with us to see if routine medications should be taken the day of the sedation. Also, report any allergies or reactions to medications that your child has experienced.
Food and liquids must be restricted in the hours prior to sedation. Fasting decreases the risk of vomiting and aspirating stomach contents into the lungs, a potentially life-threatening problem.

4. Sedation Instructions

5. Questions to review with the parent before giving sedation to a child…
(Have the patient’s Health History Form and Consent Form in your hand)
Has ______ had anything to eat or drink this morning, including water?
Have there been any changes in ______’s medical history?
Is ______ taking any medication?
Does ______ snore? Occasionally? Frequently?
Have you ever given ______ Benedryl? What’s the reaction: sleepy or excited?
Has ______ been sick, any coughing, sneezing, running nose, or fever?
If the parent says allergies, ask the cause, when are his/her allergies at their worst and does ______ need medication for allergies?
If the parent says the child has a history of asthma, ask: when was his/her last attack? What causes an attack? Does he/she take medication daily for asthma; did he/she take any today? Has ______ ever been hospitalized for asthma?

6. Sedation Record

7. Intraoperative Management & Post Operative Monitoring

8. Treatment Day
When patient arrives, click on that patient, move mouse to status and click on “patient sedated.”
Next open patients chart and read past history of patient, for any health, behavior issues, or any special instructions for sedation. Also review health history in paper chart.
When getting patient review with the parent; patients age, health; make sure they are NPO, and in good health (not suffering from a cold or allergies). Ask parent if the patient snores at night.
(If the patient does snore you will need to look at the tonsils when pt is brought back, before the patient is sedated and then report to the doctor the looks of the tonsils. If they are “kissing”, large, or normal, the doctor may decide to check the tonsils, depending on what you report. If patient has a cough the doctor may also want to listen to the patients lungs before they are sedated, if so have the stethoscope ready for them.)
Review with the parent that you will take the child back weigh them and according to their weight administer the sedation medication. Once the child has been given the sedation they will be sent back out with parent. **If parent wants to come back let them know it is okay while the patient is being sedated but when we come to get the patient for the work we will be taking the patient back by themselves (unless doctor has made prior arrangements with parents).
When patient is back to sedate, begin by weighing the child. After the child has been weighed, you can send patient over to play at the video games in back office. If the parents did come back with the patient have them with patient wait in a consult room.
Write down all the information on the sedation record. Take that and the sedation dosage guidelines to the doctor. You will need to review with the doctor the patient’s age, weight, treatment to be done that day, past behavior and their health. The doctor will give you the dose of medications to give to the patient, you will need to make note of it on the sedation sheet.
Mix the medications together in a cup. Take the medication and a cup of water over to patient and have them drink the medication and offer them a small amount of water. Make sure they drink all of the medication. If they should spill, spit or throw up any of the medications given, you will need to inform the doctor, since this could affect the outcome of the sedation. **Sometimes it is a challenge to get the kids to drink the medications, if this should arise get another assistant to help you out.

9. Treatment Day Continued
Bring patient back into waiting room. Explain to parents that patient is not to play in the playhouse or video games, it stimulates them too much. They can watch a movie or read a book. Inform parent(s) we will be back out to retrieve patient in approximately 30-45minutes. Let parent know that if the child falls asleep or becomes irritable let the PR desk know and they will get a dental assistant. At that time the assistant will bring child back to designated workroom. If there is no room available, bring patient into a consult room. If child is sleeping, bring a pulse oximeter into the room to monitor the child.
After you have brought the patient out to waiting room the assistant will need to make appropriate notes regarding the sedation. In the patients chart under clinical notes, click on “insert dateline”, note the sedation time (time when patient actually finished drinking medication), the amount of each medication given to patient, and how they took the medicine (by cup or syringe). On the doctor’s sedation pad, note the patients name, parents name, phone number, and brief treatment description. Then from the appointment book double click on the patient sedated. This will bring you to the appointment information screen. In the field marked “desc”, note the time of sedation, …).
At appointed time retrieve patient from waiting room and bring back to designated chair. Place child in papoose board, be sure to use wrist restraints on the smaller patient, also use neck roll to keep airway open. Note… it is not always necessary to use papoose board and restraints on older sedations.
At this time place pulse oximeter on child’s finger. Ask child which flavor that they would like to smell, (orange, bubblegum, strawberry or grape). Place flavored hood on the child’s nose. Administer Nitrous/Oxygen at 2/5 liter ratio.
During sedation appointment the patient should be monitored. On the sedation record, note the time, N2O/O2, pulse, and O2 saturation. These stats should be taken every 15 minutes and noted on the record sheet. Upon completion of the sedation appointment you will be required to fill out the restraints used, sedation level, effectiveness of the sedative, complications/side effect, future sedation plans, and the child’s condition on discharge.
At the end of the sedation appointment the appropriate notes will need to be entered into the computer, under clinical notes. Start under the notes already in field. Make sure to enter on one line, the appointment time, (this is when patient was scheduled to be brought back not the time of sedation), doctors name, assistants name, and patients behavior during sedation. Behavior is documented with #s, 0 the worst and 4 being the best. Next note the work done that day, and the products used. You will also need to note any after care directions or special instruction given to parent. Make sure all this is done before bringing patient out for parents. If the doctor and parents talk in consult room after check out make the required addition or changes to notes.

10. Treatment Day continued to completion
When sedation work is done make sure the patient has been on oxygen for at least 5 minutes before you have them sit up. Clean up patient if necessary, their hair may be sweaty if they worked hard, or they may have some blood around their mouth. Have patient sit in chair while making all the last minute notes. Give them the nosepiece they picked out and place it in the sedation bag. Make sure sedation bag has all the items in it, 1 juice, 1 pudding, 1 fruit cup or applesauce, 1 pencil, and 1 sticker. The doctor’s will sometimes give the patients a “special prize” if the visit has been long, the patient worked hard, or the patient did really well. If so let the patient pick out a stuffed animal.
When all this is done you can then walk patient to a consult room. The front desk will come and get the patients chart from assistant, and will then go get the parent from waiting room. The front desk will get them checked out before bringing them into consult room.
Review with the parent how the patient did during sedation, if they slept or if they were awake…etc. Review what work was done today and any post-operative instructions for specific work. Let the parent know that the patient could sleep anywhere from 1-5 hours Review with them that it is important to keep the airway open while patient sleeps; suggest they roll a hand towel up and place it under the patients neck while sleeping. DO NOT let the child sleep in a position with chin on chest. If patient is numb review with them where, how long we anticipate the local anesthetic to last, and to stick with soft diet. Let parent know patient may experience nausea and it is always best to start them on a soft, bland diet. Remind them that there is no running around for the remainder of today, it needs to be an easy day since the medication can stay in their system all day. Ask the parent if they have any questions for the doctor or if they want to speak to the doctor.
At the end of the day the doctor who was with the sedation calls to check on the child and will put the notes from the call in the computer under clinical notes. Make sure the doctor gets the doctor’s sedation pad with the information on it.

11. After Sedation Treatment
After the sedation appointment:
Once home, your child will still be drowsy and must remain under adult supervision until fully recovered from the effects of the sedation. If your child wants to sleep, position your child on his/her side with the head supported and the chin up. During this period, check your child’s breathing and airway every 3-5 minutes. If your child is snoring, reposition the head until the snoring disappears and your child breathes normally. If breathing becomes abnormal or you are unable to arouse your child, contact emergency services call 911 immediately.
Nausea and vomiting are occasional side effects of sedation. If vomiting occurs, immediately clear the material from your child’s mouth. Once again, be sure that breathing is normal. If breathing becomes abnormal or you are unable to arouse your child, contact emergency services call 911 immediately. If vomiting persists for 20 to 40 minutes, contact our office immediately.
Your child may be drowsy for some time after the sedative appointment. Restrict activities for the remainder of the day. Prohibit potentially harmful activities such as bike riding, swimming, using playground equipment, or any activity where balance is important.
In addition to the sedative medications, we often use local anesthetic to numb the mouth during dental treatment. The numbness usually lasts 2-4 hours. Watch to see that your child does not bite, scratch, or injure the cheek, lips, or tongue during this time.
Children may be irritable after treatment. If this occurs, stay with your child and provide a calm environment. If you believe the irritability is caused by discomfort, you may give your child acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). Follow the instructions on the bottle for dosing based upon your child’s age/weight.
Once your child is alert, you may give him/her sips of clear liquids to prevent nausea and dehydration. Small drinks taken repeatedly are preferable to large amounts. The first meal should be something light and easily digestible (eg soup, Jell-O®, apple sauce). Do not give fatty or spicy foods (eg, French fries, tacos, salsa, milk, cheese or yogurt).
A slight fever (temperature to 100.5°F) is not uncommon after sedation. You may give your child acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). Follow the instructions on the bottle for dosing based upon your child’s age/weight. Because dehydration may cause a slight increase in temperature, clear fluids may help correct this condition. If a higher fever develops or the fever persists, call our office.
Please feel free to call the office for any questions or concerns that you might have.
Additional instructions: ______________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________