Monitoring Equipment and Its Essential Value in the Dental Sedation Setting

Monitoring Equipment and Its Essential Value in the Dental Sedation Setting

Keeping an eye on your patient’s vital signs over the course of your procedure is not only crucial to maintain safety—it’s also a dental board requirement. Let’s examine each of the pieces of equipment used to appropriately measure and document your patient’s vital signs.

1. Stethoscope
2. Blood Pressure Cuff
3. Pulse Oximeter
4. Capnometer

Stethoscope

Every kid growing up who wants to be a doctor imagines themselves with a stethoscope around their neck, but what the heck is it actually used for? Did you ever use it in dental school?

The stethoscope is a useful way to detect breath and lung sounds, and most of them have two sides. You’ll notice that one side is a larger bell shape and the other is a smaller bell shape. You may be surprised to find out that both sides can be used to listen to different parts of the human anatomy. The larger side, called the diaphragm is the one most commonly used to listen in the lung quadrants. The practice of listening through the stethoscope for ventilation is called auscultation.

Before every dental sedation practitioner sedates their patient, they should auscultate the lung quadrants as part of their pre-screening and baseline vital sign assessment. Everyone’s lungs sound a little different, and listening to this particular patient’s lung sounds is a great way to familiarize yourself with where they are at baseline. That way, if something changes throughout the procedure, you have a point of reference. If a patient becomes bronchospastic, for example, their lungs may demonstrate a wheezing sound. You don’t want the first time you ever listen to your patient’s lungs to be when they’re wheezing—so using the stethoscope prior to the start of your sedation case is a great way to set yourself up for success in recognizing bronchospasm.

The other side of the stethoscope has a smaller bell, and you can twist the stem at the base of the two bells to click it into place to select the larger or smaller side for listening. Tapping on the larger side can give you a quick and easy indication of whether you’ve selected the desired setting. The smaller side of the stethoscope is called the precordial side, and it can be used at the tracheal notch to verify ventilation by listening for breath sounds.

Blood Pressure Cuff

Another essential piece of monitoring equipment is the blood pressure cuff. Most states require dentists to document the patient’s blood pressure every five minutes, and you can set your monitor to automatically cycle the blood pressure at five-minute intervals. Monitors will often have a button that says NIBP, which stands for non-invasive blood pressure. You can tap this button whenever you want to get a fresh blood pressure reading.

A common mistake new practitioners make with the blood pressure cuff is putting it on backwards. When the cuff inflates, the Velcro isn’t situated in such a way that it remains intact, and it slowly peels off the patient’s arm as the cuff grows larger. To avoid this silly blunder, make sure you take a look at the markings on the cuff, which will indicate which side goes toward the patient’s arm.

Pulse Oximeter

Next, let’s turn our attention to the pulse oximeter. This device clips onto a patient’s digit to measure the level of hemoglobin in the passing blood using a laser. It presents a score out of 100 to tell you the percentage of oxygen saturation in the patient’s blood.

Some fingernail polish can prevent the laser from obtaining an accurate reading, so be mindful of this. Workarounds can be fairly simple: the pulse oximeter will work just as well clipped onto a toe, and there are also models that can be clipped onto an earlobe.

Capnometer

The capnometer is a tube placed under the patient’s nostrils that feeds into a device in your monitor to measure the level of CO₂. As we breathe in and out, our lungs exchange the oxygen in the room air for carbon dioxide. The presence of exhaled CO₂ indicates gas exchange between the lungs and the external environment. This is known as ventilation, and it’s a key indicator when diagnosing the underlying cause of hypoxia.

We recommend that all sedation practitioners use a monitor that has integrated CO₂ reading. Capnography is becoming more and more of a required monitoring element for dental sedation documentation at the level of state board regulations. For practitioners who like to provide supplemental oxygen via nasal cannula, there are options that combine oxygen delivery and CO₂ sampling in one unified nasal cannula line.

ECG

In order to monitor the electrical activity of the heart, a three-lead ECG connection is required. This involves a cable that splits into three attachments, which snap onto conductive stickers placed on your patient. Each of the leads has a different color: red, white, and black.

We’ve heard many turns of phrase to help people remember which lead goes where. Our favorite is:

• White on the right, and
• Smoke over fire (place the black lead—smoke—on the patient’s upper left, and the red lead—fire—on the lower left).        

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Clinical Pearl: Here’s a tip from our experienced practitioners—snap your lead stickers onto your leads before you place the stickers on the patient. If you place the stickers first and then snap the leads on, it may cause you to press extra firmly on the patient’s body and cause discomfort.