Improving Dental Sedation for Rural Alberta
TCI – Maximizing Safety while Minimizing Risk
- Stable, steady-state drug concentrations in the plasma and brain that are readily adjusted through controlled titration.
- Software models take into account patient variables such as age, gender, height, and weight.
- Precision administration of short-acting drugs with rapid onset and offset.
- Enhanced drug properties: pharmacology, titration, and effect.
- Drug synergism: risks and benefits.
- Controlled titration to meet:
- patient and practitioner need
- patient variability
- procedural stimulus
- extremes of age and patient frailty
- early home readiness with less cognitive impairment
- Steady-state drug concentrations regardless of varying procedural times: very short <30 mins; short < 60 mins; moderate < 120 minutes; or long >120 mins
- Immediate Plan B in the event of over-sedation
- Adaptability and practical solutions in the non-hospital dental environment.
- Health Canada-approved pumps and drug medications for dental usage.
Safety will be optimized if practitioners use defined methods of sedation for which they have received formal training. The Alberta Dental Society of Anesthesiology proposes a pilot project for Alberta that includes up to six dental offices.
This pilot project is supported by Competency-based Training and appropriate oversight, allowing Alberta Health and the College of Dental Surgeons of Alberta the opportunity for formal assessment and an evidence-based decision-making process.
The first step is a collaborative meeting between the Alberta Dental Society of Anesthesiology, the College of Dental Surgeons of Alberta and Alberta Health to establish a mutually agreed process.
Why choose TCI sedation to complement the current Standard of Care in Alberta? A Proposal for a Pilot Project in Alberta.
Standard of Care in Alberta (College of Dental Surgeons of Alberta – Sedation Standards of Practice):
- Drugs: midazolam (sedative); fentanyl (opioid/analgesic)
- Administration: intermittent bolus administration by hand syringe into an i.v. line Appropriate for 30- to 60-minute dental procedures.
- Over 50 years in practice and no longer meeting dentist and patient needs
Why? Protects and serves the public interest.
1. Overall System
- Improved patient care and healthcare outcomes
- Improved access to care, especially in rural communities
- Increased safety and reduced risk
- Proven drugs, and administration technology for moderate sedation: > 20years
- Mature technology: > 25 million cases in Europe in the past decade and over 100,000 dental sedations in New Zealand
- Improved choice – patients and practitioners • Improve drug properties, pharmacology, and effect
2. Stable, steady-state drug administration
- Improved decision-making during titration – enhanced safety
- Overcomes problems of oscillation of drug effect
- Stable drug effect irrespective on length of procedure
- Clinician controls the pump; the pump controls drug administration – reduced human error • Specific drug software for each drug – improved safety • Improved drugs – pharmacology, pharmacokinetics, pharmacodynamics and drug synergism
3. Precision drug administration
- Reduced human error and risk
- Software adjusts for patient variables – age, gender, height, and weight
4. Rapid onset and off-set of drug
- Ability to incrementally increase or decrease drug effect – improved safety
- Ability to immediately decrease drug effect in the event of over-sedation – reduced risk • Earlier home readiness and decreased cognitive impairment
5. Patient preference
- Choice
- Clear-headed recovery with an overall feeling of well-being
6. Clinician preference
- Choice
- More control over-sedation
- Stable sedation throughout procedure length, with flexibility to increase or decrease sedation effect as needed
- Ability and flexibility to alter each drug concentration and effect – improved patient care, safety and reduced risk
Health Professions Act of Alberta, April 2019