Patient Evaluation and Assessment

Patient evaluation and pre-sedation assessment is crucial in determining the patient's suitability for sedation, for choosing an appropriate technique, and in preventing unwanted complications and emergencies. The pre-sedation assessment starts with a detailed review of the medical and dental histories. Allergies, history of adverse reactions to drugs and prior sedation experiences should be clearly noted. All positive responses by the patient should be clarified further and notated. For example, if the patient answered yes to asthma, further information about causes, frequency, date of hospitalization if any, and medications should be obtained and noted.

The pre-sedation assessment, especially for patients considered for moderate to deep sedation in the dental office, should also include baseline vital signs, weight, airways evaluation (Mallampatti classification), status of major organ systems, and the patient's American Society of Anesthesiologists (ASA) Physical Status (PS) classification (Table 2).35 Patients with PS I and PS II are good candidates for sedation in the general dentist office. A patient with PS III may be treated with caution as an outpatient by a well-trained provider.

Table 2. The ASA PS classification with examples.
ASA Classification Physical Status Examples
I Healthy patient No known systemic disease. Non-smoker.
II Mild or well-controlled systemic disease Smokers, healthy pregnant, well-controlled Hypertension, controlled asthma, type II diabetes
III Multiple or moderate controlled system disease that is not life threatening Type I Diabetes, stable angina
IV Poorly controlled systemic disease that is a constant threat to life. Unstable angina, CHF needing oxygen supplement. Chest pain, recent myocardial infraction.
V Moribund patient, not expected to survive without intervention End stage cancer or end stage vital organs
VI Deceased patient on perfusion support