Clinical Professor Dept Anesthesiology SUNY @ Buffalo
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Introduction: There is a growing need for pediatric dental sedation, particularly in underserved urban areas. Limited access to hospitals and ambulatory surgical centers has increased reliance on office-based sedation, which requires skilled providers and close airway monitoring. Our office uses oral, moderate IV, and deep IV sedation. We hypothesized that, using the same provider, lighter sedation would result in lower procedural success but fewer airway interventions. We also proposed a traffic light model for classifying airway interventions: Green (acceptable), Yellow (possible), and Red (complication).
Methods: After IRB approval, we retrospectively reviewed charts for all pediatric and oral surgery patients sedated in our office between Jan - Dec 2021. Sedation outcomes were assessed using a Behavior Score (higher = better) and an Airway Score. The Behavior Score reflected sedation depth, movement, noise, procedure completion, and over-sedation. The Airway Score evaluated oxygen need, airway manipulation or instrumentation, sedation adjustments, and procedural delays. Cases were grouped by sedation type: PEDO PO/IN, MOD IV, DEEP IV, and oral surgery (OS). Special needs patients were analyzed separately.
Results: A total of 1,169 cases were reviewed: 335 PEDO PO/IN, 136 MOD IV, 330 DEEP IV, and 368 OS. Mean age was 6.4 years; average BMI was 17.4. Behavior Scores averaged 7.6 ± 1.8 for MOD IV and 9.3 ± 1.1 for DEEP IV (p < 0.0001). Airway Scores averaged 9.2 ± 1.4 (MOD IV) and 6.2 ± 1.3 (DEEP IV), p< 0.0001. Special needs patients showed differences in demographics and dosing but similar sedation outcomes. The traffic light system revealed that deeper sedation allowed more invasive—but appropriate—airway interventions. Repeated chin lifts occurred in ~80% of deep sedation cases and were reclassified from Yellow to Green.
Conclusions: Deeper sedation resulted in better procedural outcomes but required more airway interventions. The traffic light system provided a structured method to classify airway events by sedation type, aiding in interpretation of outcomes. In-office deep sedation demands advanced airway management skills, reinforcing the importance of trained providers. This system may also serve as a useful reference for ICU physicians delivering procedural sedation.
