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HEALTH ANSWERS

Is sedation safe for children undergoing dental procedures or medical tests like MRIs?

Generally, yes. But better monitoring of children during these procedures is essential, as the death last fall of a 5-year-old Chicago girl following sedation for dental work shows.

Late last year, shortly after the girl's death, two major groups, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry, came out with joint guidelines that had long been in the works to make pediatric sedation safer.

The primary author of these, and previous, guidelines, Dr. Charles Coté , a pediatrician and anesthesiologist at Massachusetts General Hospital, said that the new guidelines represent "a huge step in the right direction." In part, he said, that's because they make clear that medical personnel administering sedation to children should follow the same rules whether the procedure takes place in a hospital or in a private medical or dental office.

The guidelines do not have the force of law, but many states use the guidelines in creating laws governing practice.

Children often need drugs to reduce anxiety, provide pain relief, or reduce movement during normal dental procedures such as filling a cavity, and some medical tests, like MRIs. The problem, said Coté , is that a child may become more deeply sedated than the doctor or dentist intended and therefore must be monitored very carefully until fully awake.

The new guidelines make clear that the person doing the procedure must have "advanced airway training" (be able to clear an obstruction in a child's airway and, if necessary, be able to pump air into a child's lungs with a bag and mask) and use a pulse oximeter to check oxygen levels in the blood as well as other measures to make sure the child is breathing, said Dr. Stephen Wilson, a spokesman for the American Academy of Pediatric Dentistry and chairman of the division of pediatric dentistry at Cincinnati Children's Hospital Medical Center.

Parents should ask their child's dentist or doctor if he or she follows the new guidelines, which are available at aapd.org.

JUDY FOREMAN

Please e-mail health questions to Foreman@globe.com.

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