Working on sedated patients is an experience that can be
very useful in a clinical learning experience, but can also be a challenge. Here
are three factors that I learned can be important in a case dealing with
sedation, specifically general anesthesia. (Note that I am only a student and
have learned most of these skills with a dental anesthesiologist or nurse anesthetist
present at the University of Pittsburgh Center for Patients with Special Needs.)
should be the first thing in any situation when working with multiple doctors
in treatment, but nonetheless I believe that clear communication is most
important. First, make sure that the anesthesiologist is ready for you to
begin. Make clear that you have finished treatment. If you can, give updates as
to where you are in the procedure. Often in the Center for Patients with
Special Needs we use handheld x-ray systems for taking radiographs. It is
important to let everyone else in the room be aware of the radiation exposure
that is occurring.
An airway is an
airway. Whether intubated or open,
the airway is something to always consider. It takes up more of the focus when
the patient is not intubated because there is a higher risk of aspiration. Even
with a throat pack, it is still an airway when they wake up. This is when your
assistant plays an important role. Especially when working with a new assistant,
it is important to state your expectations. Communication comes into play again
in that the anesthesiologist will sometimes need to communicate when oxygen
stats are getting low and some type of chin lift needs to be performed. Makes
sure your assistant and anesthesiologist are also communicating as well.
Be ready for wake up.
Though the dental part of the procedure is completed, wake up can either go
very easily or with complications, especially working with an anxious or
special needs patient. It is important to be ready to help the anesthesiology
team if the patient wakes up in an aggressive state. My most memorable wake up
occurred early in my clinical experience when I was just told to be ready in case
the team needed help putting the patient in the wheel chair. About five minutes
later, there were six of us wrestling her into the wheelchair after she woke up!
Sedation can be a very useful part of dentistry, especially
for patients with special needs. It is
important to use caution and make sure the techniques that you are using are
correct. Dental anesthesiology is an expanding field in dentistry and is worth exploring
for your own patients.