AAPD Reference Manual 2022-2023

BEST PRACTICES: MONITORING AND MANAGEMENT OF SEDATION

495. Litman RS, Kottra JA, Verga KA, Berkowitz RJ, Ward DS. Chloral hydrate sedation: The additive sedative and respiratory depressant effects of nitrous oxide. Anesth Analg 1998;86(4):724-728. 496. American Academy of Pediatric Dentistry, Council on Clinical Affairs. Guideline on use of nitrous oxide for pediatric dental patients. Chicago, Ill.: American Academy of Pediatric Dentistry; 2013. Available at: “http://www. aapd.org/media/policies_guidelines/g_nitrous.pdf ”. Accessed May 27, 2016.

Supplemental Information Appendix 1. Recommended Discharge Criteria 1. Cardiovascular function and airway patency are satisfac- tory and stable. 2. The patient is easily arousable, and protective airway reflexes are intact. 3. The patient can talk (if age appropriate). 4. The patient can sit up unaided (if age appropriate). 5. For a very young child or a child with disability who is incapable of the usually expected responses, the preseda- tion level of responsiveness or a level as close as possible to the normal level for that child should be achieved. 6. The state of hydration is adequate. Appendix 2. ASA Physical Status Classification* Class I A normally healthy patient. Class II A patient with mild systemic disease (e.g., controlled reactive airway disease). Class III A patient with severe systemic disease (e.g., a child who is actively wheezing). Class IV A patient with severe systemic disease that is a constant threat to life (e.g., a child with status asthmaticus). Class V A moribund patient who is not expected to survive without the operation (e.g., a patient with severe cardiomyopathy requiring heart transplantation). An “E” after the classification would indicate that this is an emergency rather than a scheduled patient. * Modified to give common pediatric examples; full definitions are available at: “https://www.asahq.org/clinical/physicalstatus.htm” . 491. Lee JH, Kim K, Kim TY, et al. A randomized comparison of nitrous oxide versus intravenous ketamine for lacera tion repair in children. Pediatr Emerg Care 2012;28(12): 1297-301. 492. Seith RW, Theophilos T, Babl FE. Intranasal fentanyl and highconcentration inhaled nitrous oxide for proce dural sedation: A prospective observational pilot study of adverseevents and depth of sedation. Acad Emerg Med 2012;19(1):31-6. 493. Klein U, Robinson TJ, Allshouse A. End-expired nitrous oxide concentrations compared to flowmeter settings during operative dental treatment in children. Pediatr Dent 2011;33(1):56-62. 494. Litman RS, Kottra JA, Berkowitz RJ, Ward DS. Breathing patterns and levels of consciousness in children during administration of nitrous oxide after oral midazolam pre- medication. J Oral Maxillofac Surg 1997;55(12):1372-7; discussion: 1378-9.

Appendix 3. Drugs † That May Be Needed to Rescue a Sedated Patient 44 Albuterol for inhalation Amiodarone Ammonia spirits Atropine Dextrose (D 25 ) Diphenhydramine Diazepam Epinephrine (1:1000, 1:10 000) Fentanyl Flumazenil Lidocaine (cardiac lidocaine, local infiltration) Lorazepam Methylprednisolone Midazolam Naloxone Oxygen Fosphenytoin Racemic epinephrine Rocuronium Sodium bicarbonate Succinylcholine 20% Lipid emulsion for local anesthetic toxicity † The choice of emergency drugs may vary according to individual or procedural needs.

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THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY

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