In addition to blood volume and contractile strength, the heart must sustain a regular cycle of relaxation and contraction if it is to fulfill its objective. The output of the heart per minute (cardiac output) is the paramount cardiovascular event required to sustain blood flow throughout the body. The purpose of this Continuing Education article is to provide fundamental concepts of ECG recognition that will enable the dentist to feel more comfortable with the routine use of dynamic ECG monitoring. This of course presumes that the operator is comfortable witnessing occasional benign arrhythmias and the subtle mechanical nuances all monitors present during routine use. Despite this controversy, a growing number of state dental boards are requiring ECG monitoring for general anesthesia and all levels of intravenous sedation.ĭisregarding these legal controversies, there is an intangible reassurance provided by an ECG monitor that adds to that provided by periodic measurement of blood pressure and continuous pulse oximetry. 2 Most publications in the medical anesthesia literature regard ECG monitoring as a standard for both sedation and anesthesia, 3 but many experts question its actual value in preventing sedation-related morbidity and mortality among patients without preexisting cardiac risk. The American Dental Association recently revised its monitoring guidelines to include ECG monitoring for all deeply-sedated patients and for consciously-sedated patients with compromised cardiovascular function. 1 The guidelines at that time also encouraged ECG monitoring during deep sedation, but not during moderate (conscious) sedation. The American Dental Society of Anesthesiology included pulse oximetry for patient monitoring in its guidelines published in 1991. Dynamic electrocardiographic (ECG) monitoring is a standard of practice when providing general anesthesia, but opinions are mixed regarding its use during moderate (conscious) and deep sedation.
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