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Jan 16
Priorities for Sedation

This fall we heard the terrible story of the sedation incident with young Amber Atwal in Edmonton. This child had a general anaesthetic (GA) sedation procedure provided by a dentist, after which she suffered a brain injury. My heart goes out to this family and, as a father myself, I understand why they are demanding answers.

Although this incident took place in another province, the College has fielded multiple requests for information about sedation dentistry. On one hand, I can reassure patients in B.C. that we do not allow a single-operator model for GA. I am very pleased to report that GA standards and guidelines were already at a very high level and were much safer than what was the standard in many other provinces. (You can read our statement here.)

On the other hand, the job of protecting the public is always evolving and, through the Sedation Committee, the Board is making the following changes:

  1. Addition of capnography (end-tidal CO2) monitoring to deep and moderate sedation standards and guidelines. Recent changes to both the ADA and AAPD/AAP documents mandated the use of this monitor. Changes to the B.C. documents now bring us on par with our U.S. counterparts and ahead of almost all provinces (in fact, I think we are the first in Canada to mandate this for dentistry).

  2. The deep sedation/GA standards and guidelines are presently under review. A working group has been formed to take on this task. The working group is comprised of a biomedical engineer, a medical anesthesiologist, a general dentist with advanced training in anesthesia (DA), and two oral surgeons. The sedation committee will be asking users of the present document to give input on what changes they would like to see in the new document.

  3. A second subcommittee has been formed to look into pediatric sedation. As you know, children present the highest risk and lowest error tolerance during sedation procedures. This committee with be considering our present requirements and suggest changes that will make the sedation of children safer in B.C. 

  4. The Board placed a moratorium on new applications to register credentials to provide moderate pediatric sedation for dentists who have learned the modality in a short-course format. The moratorium (PDF) will last for a year, giving the Sedation Committee time to conduct an analysis and make its recommendations on the safety of this modality.

  5. We have re-structured the Sedation Committee based on a recommendation from the Governance Committee and approved by the Board. The Committee is now composed of five oral-maxillofacial surgeons, six general dentists, two pedodontists and a periodontist, in addition to two medical anaesthesiologists and a biomedical engineer.

 

At the same time, the committee will continue its ongoing work of inspecting all moderate, deep and GA facilities to ensure that they are complying with our requirements.

Led by Dr. Toby Bellamy, this committee is incredibly dedicated. I can tell you that I am impressed by both the work ethic and work volume from the committee members. I have a new-found respect for what this committee has accomplished, and for its focus on public protection.

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