The most important characteristic to monitor during sedation is consciousness. With that, there are three key elements to keeping your patient safe at all times, this includes:, ,1. Patient selection.,2. Avoid sedating the very young, the very old, and the very sick.,3. Keep your patient conscious. (DOCS only teaches conscious sedation), ,Therefore, the risks grow as your patient becomes increasingly sedated. Monitoring vital statistics, monitoring patient’s airway, and supporting their natural characteristics that help them breathe and maintain their life functions are also imperative. Maintaining verbal responsiveness with your patient throughout the procedure is also vital., ,Goals of Monitoring,• Observe Consciousness,• Verbal Responsiveness,• Monitor Physiological Parameters,• Heart Rate,• Oxygen Saturation,• Blood Pressure,• End Tidal CO2, ,Usually the mind goes to the machine that is measuring the vital statistics. However, the most important thing you’re monitoring on the patient during sedation is consciousness, and this is done by interacting directly with the patient, not by reading monitors., ,Pre-Sedation Baselines, ,“Normal” for the patient should exist within the following ranges for ASA1 and ASA11:,• Preferred heart rate of: >60 and <100,• Preferred blood pressure of: <120 systolic and <80 diastolic,• Preferred 02 saturation of: > 96%,• Preferred EtCO2 of: 40mm HG +/- 5 mm, ,When the preoperative heart rate and blood pressure are above these preferred levels, the patient’s anxiety is often contributing. Taking readings without the doctor present can provide a more reliable and consistent measurement of the patient., ,Lower-than-normal heart rate and blood pressure readings are often found in patients in excellent physical condition. When abnormal cardiovascular baseline values cannot be explained by anxiety alone or excellent physical condition, a medical consultation should be obtained. , ,As with any atypical measurement, the inaccuracy of the monitoring equipment must also be ruled out. Key points to remember include:,• Do not sedate without high-quality monitoring equipment. It’s also important that all team members know how to use the equipment and how to set the alarms.
• Pulse, blood pressure, oxygen saturation, and end-tidal CO2 measurements are required to measured, monitored, and recorded throughout entire treatment. ,
,Monitoring Heart Rate, ,When a patient is sedated, their heart rate may slow down due to the activation of the parasympathetic system, the release of acetylcholine, and the activation of its receptors., ,This decrease in heart rate is to be expected, and less of a concern compared to tachycardia, which increases the risk of an adverse cardiovascular event. Additionally, there is particular concern when an absence of a P wave on an EKG accompanies the tachycardia, which can be a sign of heart block, ventricular tachycardia, or fibrillation., , Certain medical conditions can affect the patient’s heart rate. Examples of ailments that can increase heart rate include: ,• Atherosclerosis
• Congestive Heart Failure
• Myocardial Infarction
• Congenital Heart Defects
• Inflammatory or Degenerative Heart Disease
• Myocarditis (Infection of the Heart)
• Chronic Lung Disease
• Hypertension
• Hyperthyroidism
• Electrolyte Imbalance
• Emotional Stress
,Medications that can cause tachycardia include: ,• Asthma Medicines
• Antibiotics
• Cough, Cold, and Allergy Medicines
• Thyroid Medicine
• Antidepressants
• Supplements
,Monitoring Blood Pressure, ,Patients diagnosed with regular or prehypertension are acceptable candidates for sedation. Given all other health conditions the patient might have, it’s acceptable for a patient with stage 1 hypertension to also be sedated, provided the consult with their PCP or cardiologist determines their hypertension to be under acceptable control. , ,However, patients with stage 2 hypertension are not candidates for sedation until their condition is successfully managed., ,Abnormal Blood Pressure During Sedation, ,The blood pressure of a sedated patient should be lower than their baseline blood pressure, but significant differences may still occur. This is due to the following reasons:, ,• Sedation medications,• Existing medications,• Skipped or missed medication dose,• Patient discomfort,• Indication of a possible cardiovascular event,• Monitoring equipment, ,It’s important to remember the blood pressure cuff size you’re using in regard to each patient. For instance, if the cuff is too small for the patient, the BP reading will be artificially high. Conversely, if the cuff is too large for the patient, the BP reading will be artificially low. And if the BP is taken on an extremity above the level of the heart, the reading will also be artificially low. , ,Monitoring Oxygenation,Oxygenation is the most critical factor among the various physiological measurements assessed during conscious sedation. While heart rate and blood pressure are also monitored, they are typically supported by the sedation process, making them less critical compared to oxygenation. ,Although end-tidal CO2 measures ventilation, oxygenation is a more revealing number in conscious sedation patients. Since they are not intubated, the reliability of capnography/capnometry measurement is less pertinent. Therefore, it is crucial to monitor oxygenation in order to detect any potential negative impacts of conscious sedation., ,The pulse oximeter measures oxygenation by reflecting the percentage of available hemoglobin sites that are occupied by oxygen. The difference between the percentage of oxygenated hemoglobin and the tissues that need it determines the efficiency with which oxygen is delivered. Therefore, it is most desirable that the percentage of oxygenated hemoglobin measured by the pulse oximeter be as high as possible to ensure optimal oxygenation of tissues., ,Monitoring End-Tidal Co2, ,End-tidal CO2 Monitoring (ET CO2) measures a patient’s exhaled carbon dioxide, which reflects the metabolic processes of ventilation. Oxygenation measures how much oxygen the blood carries, while ventilation measures the carbon dioxide produced by oxygenating tissues (cellular metabolism)., ,As a result, it can be used to determine the effectiveness of ventilation and oxygenation in a patient’s body., ,ET CO2 also has the advantage of being a more real-time measurement than SpO2. As a general rule, expired CO2 rises before oxygen saturation decreases., ,In Conclusion, ,Maintaining patient consciousness is of the utmost importance during sedation. Therefore, dentists must start by selecting patients who are appropriate candidates for sedation., ,While monitoring equipment is essential, direct interaction with the patient and verbal responsiveness are critical in assessing consciousness and ensuring patient safety throughout the procedure. Properly trained dental professionals prioritize monitoring procedures to mitigate risks and ensure the patients’ well-being during sedation., ,This proactive approach ensures that emergencies and complications are avoided during sedation appointments. As a result, patients will be satisfied and safely treated, and staff will be prepared to provide excellent patient care., , ,Author: With over 14 years as a published journalist, editor, and writer, Genni Burkhart’s career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.,
