The sedation team: training for divided attention

Treinamento da equipe de sedação moderada no modelo cirurgião-anestesista único

Rohit Bedi · VI EBSO, Florianópolis · 21 October 2026
References for the slides, including the backup slides.

Standards and guidelines

Brazil

  1. Conselho Federal de Odontologia. Resolução CFO-295, de 10 de julho de 2026.
  2. Conselho Federal de Odontologia. Notice of 24 August 2026 on the effects of a court decision on Resolução CFO-295/2026. website.cfo.org.br
  3. Conselho Federal de Odontologia. Resolução CFO-51/2004.

New Zealand

  1. Dental Council of New Zealand. Sedation practice standard. March 2026. dcnz.org.nz
  2. Dental Council of New Zealand. Sedation practice standard: consultation outcome letter. 30 March 2026.
  3. Dental Council of New Zealand. Sedation practice standard. November 2016, in effect 1 April 2017 (capnography required from 1 October 2019).
  4. Dental Council of New Zealand. Summary of Council decisions, May 2016; consultation outcome letter, 18 November 2016.
  5. Dental Council of New Zealand. Standards framework for oral health practitioners.
  6. Health Quality & Safety Commission New Zealand. New Zealand Early Warning Score vital sign chart: user guide. July 2017. hqsc.govt.nz

Australia and New Zealand

  1. Australian and New Zealand College of Anaesthetists. PG09(G) Guideline on procedural sedation. 2023. anzca.edu.au
  2. Australian and New Zealand College of Anaesthetists. PS08 Statement on the assistant for the anaesthetist. 2026.
  3. Australian and New Zealand College of Anaesthetists and Royal Australasian College of Dental Surgeons. PS21. 2003.
  4. ACT Dental Board. Notifiable instrument NI2007-9.
  5. Clinical Excellence Commission, NSW Health. Standard Adult General Observation Chart, SMR110.010. cec.health.nsw.gov.au

United Kingdom

  1. Intercollegiate Advisory Committee for Sedation in Dentistry. Standards for conscious sedation in the provision of dental care, V1.1. Royal College of Surgeons of England; 2020.
  2. Society for the Advancement of Anaesthesia in Dentistry. Guidance on Conscious Sedation for Dentistry 2026 (summary guidance). January 2026.
  3. Society for the Advancement of Anaesthesia in Dentistry. SAAD Safe Sedation Practice Scheme: conscious sedation complications and emergency practice scenarios. Reviewed January 2022.
  4. Standing Dental Advisory Committee. Conscious Sedation in the Provision of Dental Care. 2003.
  5. Department of Health. A Conscious Decision. 2000.

United States

  1. American Dental Association. Guidelines for the Use of Sedation and General Anesthesia by Dentists. Adopted October 2025; released April 2026. ada.org (PDF)
  2. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96(4):1004-1017. doi:10.1097/00000542-200204000-00031

Published series of operator-sedationist practice

  1. Viljoen A, Byth K, Coombs M, Mahoney G, Stewart D. Analysis of oxygen saturations recorded during dental intravenous sedations: a retrospective quality assurance of 3500 cases. Anesth Prog 2011;58(3):113-120. doi:10.2344/09-00001.1
  2. Nagels AJ, Bridgman JB, Bell SE, Chrisp DJ. Propofol-remifentanil TCI sedation for oral surgery. N Z Dent J 2014;110(3):85-89. PMID 25265746.
  3. Lobb D, Clarke A, Lai H. Administration order of midazolam/fentanyl for moderate dental sedation. J Dent Anesth Pain Med 2018;18(1):47-56. doi:10.17245/jdapm.2018.18.1.47
  4. Lobb D, Ameli N, Ortiz S, Lai H. Comparison of the effects of target-controlled infusion-remifentanil/midazolam and manual fentanyl/midazolam administration on patient parameters in dental procedures. J Dent Anesth Pain Med 2022;22(2):117-128. doi:10.17245/jdapm.2022.22.2.117
  5. Lobb D, MiriMoghaddam M, Macalister D, Chrisp D, Shaw G, Lai H. Safety and efficacy of target controlled infusion administration of propofol and remifentanil for moderate sedation in non-hospital dental practice. J Dent Anesth Pain Med 2023;23(1):19-28. doi:10.17245/jdapm.2023.23.1.19
  6. Lobb D, MiriMoghaddam M, Macalister D, Bedi R, Anderson K, Lai H. Total intravenous sedation with target-controlled infusion in dentistry: clinical experience with the third-generation Eleveld pharmacokinetic/pharmacodynamic model. J Dent Anesth Pain Med 2025;25(5):313-325. doi:10.17245/jdapm.2025.25.5.313

Other studies

  1. Coté CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000;105(4 Pt 1):805-814. doi:10.1542/peds.105.4.805
  2. Reason J. Human error: models and management. BMJ 2000;320(7237):768-770. doi:10.1136/bmj.320.7237.768
  3. Burton JH, Harrah JD, Germann CA, Dillon DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med 2006;13(5):500-504. doi:10.1197/j.aem.2005.12.017
  4. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360(5):491-499. doi:10.1056/NEJMsa0810119
  5. Deitch K, Miner J, Chudnofsky CR, Dominici P, Latta D. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial. Ann Emerg Med 2010;55(3):258-264. doi:10.1016/j.annemergmed.2009.07.030
  6. Joffe AM, Hetzel S, Liew EC. A two-handed jaw-thrust technique is superior to the one-handed “EC-clamp” technique for mask ventilation in the apneic unconscious person. Anesthesiology 2010;113(4):873-879. doi:10.1097/ALN.0b013e3181ec6414
  7. Komasawa N, Sanuki T, Fujiwara S, et al. Significance of debriefing methods in simulation-based sedation training courses for medical safety improvement in Japan. Springerplus 2014;3:637. doi:10.1186/2193-1801-3-637
  8. Eleveld DJ, Proost JH, Vereecke H, et al. An allometric model of remifentanil pharmacokinetics and pharmacodynamics. Anesthesiology 2017;126(6):1005-1018. doi:10.1097/ALN.0000000000001634
  9. Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open 2017;7(6):e013402. doi:10.1136/bmjopen-2016-013402
  10. Eleveld DJ, Colin P, Absalom AR, Struys MMRF. Pharmacokinetic-pharmacodynamic model for propofol for broad application in anaesthesia and sedation. Br J Anaesth 2018;120(5):942-959. doi:10.1016/j.bja.2018.01.018
  11. Hadfield A, Thompson S, Hall J, Diaz-Navarro C. Perception of simulation training in emergencies for dental sedation practitioners. Clin Teach 2018;15(1):52-56. doi:10.1111/tct.12626
  12. Jun J, Han JI, Choi AL, et al. Adverse events of conscious sedation using midazolam for gastrointestinal endoscopy. Anesth Pain Med (Seoul) 2019;14(4):401-406. doi:10.17085/apm.2019.14.4.401
  13. Leroy PL, Krauss BS, Costa LR, et al. Procedural sedation competencies: a review and multidisciplinary international consensus statement on knowledge, skills, training, and credentialing. Br J Anaesth 2025;134(3):817-829. doi:10.1016/j.bja.2024.07.036

Team tools

  1. Agency for Healthcare Research and Quality. TeamSTEPPS 3.0: Sharing the Care Plan: Brief. Reviewed December 2023. ahrq.gov
  2. Agency for Healthcare Research and Quality. TeamSTEPPS 3.0: Reviewing the Team’s Performance: Debrief. Reviewed December 2023. ahrq.gov
  3. Agency for Healthcare Research and Quality. TeamSTEPPS: Advocacy and Assertion. Reviewed June 2023. ahrq.gov
  4. Agency for Healthcare Research and Quality. TeamSTEPPS 3.0: Check-Back (or Repeat-Back). Reviewed July 2023. ahrq.gov
  5. RAVOC® and Safe Sedation Training (SST)® are registered trademarks of Applied Medical Visualizations, LLC. safesedationtraining.com

Cases and reports

  1. Coroners Court of Victoria. COR 2017 1795. Amended finding, 12 November 2021.
  2. R v Pegios [2008] NSWDC 105.
  3. Health Care Complaints Commission v Pegios (No 1) [2009] NSWDT 1; Health Care Complaints Commission v Pegios (No 3) [2010] NSWDT 2.
  4. Surgeon cleared of charge. The Press (Christchurch), 13 April 1991 (Papers Past).
  5. Hutchinson, Gibbs and Newson. Safety through Knowledge. New Zealand Society of Anaesthetists; 1998: p63.
  6. Otago Daily Times/NZME. Man paralysed during dental treatment still waiting for answers. 13 July 2026.
  7. RNZ. Auckland man paralysed after dental sedation still awaiting justice, 3 years on. 14 July 2026.

Course material (New Zealand Society for Sedation in Dentistry)

  1. Sedation 101: Monitoring the Sedated Patient. Course handout, May 2024 (A Biddick, R Bedi, N Stretton).
  2. Sedation 201: Team Work (P Templer).
  3. Monitoring the Sedated Patient: one-page RAVOC and vital signs sheet. 2026.
  4. Role plays for TCI simulation training, edition 1.1.

56 references. Contact: sedation@rohitbedi.co.nz
© Rohit Bedi 2026