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3 Tips for Working on Sedated Patients

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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.)

 

 

Communication. This 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.