Monday, January 08, 2007

The Pulse Oximeter in Pediatric Dental Sedations

A Pulse Oximeter is the primary monitoring system used with Conscious Sedation in Pediatric Dentistry. Used in combination with other monitoring methods, it measures the pulse rate and oxygen saturation of the blood. It is non-invasive. In fact it is just a little sensor that shines a red light accross the finger or earlobe to measure the saturation of the hemoglobin molecule. It can provide an early warning of respiratory depression and is especially useful in children. This machine also measures blood pressure. Although, in children you are likely to see a problem with oxygen saturation before BP.

9 comments:

dr.g said...

I was monitoring a sedation last week and we used a lighter oral medication on a 4y8m old. She cried through the whole thing, but was fairly cooperative. I realized the pulse ox most useful when the patients are asleep. When she was crying, the alarms kept going off and it became more annoying than helpful.

Oral sedation is such an art, I've found from our faculty. What is your method is choosing which med and what has worked best in your experience?

Keep up the good posts, hopefully we can start a good community of pediatric dentistry knowledge circulating on the web.

Dr. Dean Brandon said...

There is "motion artifact" that throws the sensor off when the child is moving. If the child is fussy, crying, or other wise moving around you pretty much know his saturation is ok and the pulse oximeter is not of much use. I really pay attention though when the child is sleepy. That's why you cannot just rely one one monitoring modality. By the way even if you give a large amount of medication you still can have a wiggly fussy patient (which is frustrating I know). Yes, as much an art as science.

Dr. Dean Brandon said...

Oh yes, which medication is the "best"? There is no magic bullet here. Every situation is different. I try and gauge the behavior at the recall appointment (anxious or defiant, gag reflex, did we get x-rays or not). Then I look at the procedure scheduled, the age of the patient, weight, past dental sedations and what worked and what didn't, and other things. Younger children needing more extensive work, well I tend to lean more towards a Chloral Hydrate/Demerol/Vistaril combination. Older kids perhaps Demerol/Vistaril combination. Really short procedures on anxious kids then Versed is good. Again it all depends. All this of course if "conscious sedation" is really indicated (which, of course with most children it is thankfully not).

Aldred said...

What are the normal heart rate values for a child say 4 to 14 while undergoing dental treatment. Lets say nitrous is being used. When should we be concerned with hypoxia or excessive heart rate (what values)
Thanks

Dr. Dean Brandon said...

Kids have faster heart rates than adults. The age range you give is awfully large. For instance a 4 year old would likely be 90-100.....You could look online to get a specific answer to that.

In kids you are really more concerned with a slower heart rate (bradycardia).

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Unknown said...

Our 2 year old son has to have 4 teeth worked on, one will probably require filling and at least 2 capping. We are concerned about the anesthesia procedure because he is so young. We have seen a pediatric dentist who does in office treatment and seems to have high ratings, but how can you verify a dentists has the proper qualifications to reliably use anesthesia on your child? The idea of general anesthesia terrifies me but I understand he need so much work done (and we want to knock it out in one sitting which the dentist thinks is fine) but I just want to know how to vet this dentist (not our usual dentist, was a referal) credentials as thoroughly as possible. Are there specific details I should ask about (beside being an MD instead of a CRNA) such as what anesthesia training they have had or what monitoring systems they use or what their contingency capabilities are in the case of emergency?

Dr. Dean Brandon said...

All Pediatric dentists (specialists) have education and training in the use of conscious sedation, and also in the treatment of children under general anesthesia, usually in a hospital setting. You could ask if the pediatric dentist is a member of the american academy of pediatric dentistry (the aapd) (www.aapd.org) Membership is not required, but gives an indication as the academy establishes guidelines for in office sedation and the necessary and expected monitoring equipment, guidelines, training etc. You can ask if he follows these guidelines. It's always ok to ask specifically about monitoring of patients for in office sedation, etc. Some pediatric dentists actually do general anesthesia or deep sedation in their office with the use of an anesthesiologist. In our office, we choose to do general anesthesia cases in the hospital. Different states have different regulations as to licensure etc.

Be aware that unless a two year old is actually asleep (general anesthesia) the reaction to medications is somewhat unpredictable. In other words he might be fussy or uncooperative even with the medications or he may be very sleepy. Unfortunately it is a difficult situation no matter what is done, or not done. I address all this more in other posts on the blog.

Read more here on the blog about sedation and general anesthesia (over there on the sidebar on the right side is a link)

sugarandspicecouture said...

My Son is 7 years old, his dentist wants to do sedation on him combination of Demerol, Valium, and Vistadril along with nitrous. Is it safe? I think it's too much