By Emma Yasinski
A meta-analysis published in the Journal of the American Dental Association earlier this year showed that regularly using capnography - a method that measures a patient’s output of carbon dioxide – during moderate sedation is safe and may help identify individuals having respiratory distress before that distress leads to dangerous adverse events or death.
While sedation – whether oral or IV – following established regulations, guidelines, and protocols is safe, it does increase the risk of complications.
To prevent such events, the American Dental Association (ADA) updates its Guidelines for the Use of Sedation and General Anesthesia by Dentists and Dental Students every few years. In an effort to properly update the next edition of its guidelines, researchers conducted a meta-analysis on the use of capnography to monitor patient safety in moderate sedation.
“The [ADA] guidelines … were being reviewed and updated and the question was whether or not capnography monitoring should be added as a monitor for adult patients undergoing moderate sedation.” William B. Parker, DDS, Associate Dean for Postgraduate Education at Nova Southeastern University College of Dental Medicine in Ft. Lauderdale and lead author of the study, told Incisor in an email.
Capnography is already used for patients who require deep sedation and general anesthesia, and the current ADA guidelines (2016) require capnography for patients undergoing moderate sedation – whether oral or IV. Accordingly, the team of researchers led by Dr. Parker noted that patients who are moderately sedated sometimes progress into deeper states during treatment.
Currently, standard monitoring techniques for moderate sedation – as recommended by the ADA – rely on pulse oximetry to measure the oxygen saturation of a patient’s blood to ensure they are breathing normally.
Dr. Parker is a board certified periodontist who is heavily involved in the clinical and didactic education of both predoctoral students and postgraduate residents. He served in the Naval Dental Corps for more than 25 years.
Dr. Parker and his team reviewed 2,892 studies and narrowed them down to 16 relevant, eligible studies. Those studies included 3,866 adults who were moderately sedated during dental procedures.
The Parker team found evidence that capnography was more accurate than pulse oximetry and more likely to detect adverse breathing events, resulting in a 30% reduction of risk of hypoxemia. However, the evidence was ranked as “low-to-moderate” quality due to the potential for bias in the studies.
Nonetheless, “the conclusion of the study was that the routine use of capnography during moderate sedation has the potential to reduce adverse anesthetic outcomes in dental practice,” said Dr. Parker. “This has a direct benefit to our patients.”
Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.
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