Paediatric dental chair Procedural Sedation and Analgesia: A follow up study

Abstract

Background The South African Society of Anaesthesiologists (SASA) paediatric procedural sedation and analgesia (PSA) guidelines provide instructions for the safe administration of paediatric PSA and the management of complications. The pilot study found a lack of adherence to the recommended safety standards among dentists in Gauteng. The departments of Anaesthesiology and Dental Science at Wits placed emphasis on “safe sedation principles” with the intention that greater awareness of the guidelines may result in improved guideline adherence. Aim The aim of this study is to determine if there has been a change in paediatric dental chair PSA practice and guideline adherence among Wits BDS graduates, after the publication of “Paediatric dental chair sedation: An audit of current practice in Gauteng, South Africa” in 2015. Methods A prospective, contextual, descriptive survey study design was used. The survey was adapted from the pilot study to define the current practice of paediatric dental chair PSA among Wits BDS graduates and determine the level of guideline adherence. The findings of the pilot and follow up studies were compared. Results The study found that 62% of dentists had no sedation training. Sixty-six percent of sedation practitioners working for dentists were sedation trained medical practitioners or anaesthetists. Twenty-two percent of dentists continue to perform the role of operator and sedation practitioner simultaneously. There remains a lack of paediatric PSA guideline adherence despite improvements in the following areas: documentation of written informed consent; implementation of fasting guidelines; use of monitoring equipment, use of staffed recovery areas and availability of emergency drugs and equipment. The proportion procedures performed under deep sedation and general anaesthesia increased as did the number of sedation related complications. The most common complications were oxygen desaturation (62%), airway obstruction (38%) and apnoea (19%). No cardiac arrest or deaths were reported. Conclusion The follow up study found a lack of paediatric PSA guideline awareness and unsafe practice of paediatric dental chair PSA among Wits BDS graduates from 2016 to 2021. The study has highlighted a need for postgraduate accredited sedation training and the ongoing audit of paediatric dental chair PSA.