Patient Safety Section Editor: Sorin J. Brull Dental Sedation by Dentists: A View From Anesthesiologists Working in Central Western Brazil Paulo S. S. Costa, MD, PhD* Wilson J. Valadao, Jr.* Luciane R. R. S. Costa, DDS, PhD† BACKGROUND: Anesthesia care has been provided by diverse health professionals worldwide, but little is known about anesthesiologists’ views about this. Using a survey, we sought the opinions of a group of Brazilian anesthesiologists regarding nitrous oxide/oxygen and oral minimal/moderate sedation performed by dentists. METHODS: A 3-part postal questionnaire was sent to 206 physician anesthesiologists working in the state of Goias, in Central Western Brazil. Part 1 consisted of 4 questions describing respondents’ characteristics: gender, time elapsed since completion of the residency program, and experience in providing sedation and general anesthesia for dental treatment. In Part 2, respondents were asked to give their opinions on 11 statements about sedation performed by dentists. Possible responses ranged from total disagreement to total agreement (minimum score = 11 and maximum score = 55). Part 3 was a section for general comments. Data were analyzed by k-means clusters,  2 , and Student’s t-test. RESULTS: The response rate was 53.8% (111 questionnaires). Most anesthesiologists (85.6%) had rarely or never provided sedation or general anesthesia for dental treatment, and 92.8% disagreed with the statement that dentists can administer moderate sedation in the dental office. Two clusters representing more favorable (n = 21) or less favorable (n = 90) opinions were established. Anesthesiologists in the “less favorable” group had more experience with dental sedation (P = 0.006) and dental general anesthesia (P = 0.008) than those in the “more favorable” group. Gender and time elapsed since residency completion did not significantly affect anesthesiologists’ opinions. CONCLUSIONS: Many anesthesiologists in Central Western Brazil do not sedate dental patients and are not confident that dentists are able to do it. Dental sedation is an issue that still needs to be clarified in this region; the respective roles of physicians and dentists need to be determined to benefit the population. (Anesth Analg 2010;110:110 –4) Minimal and moderate sedation in dental offices can be performed by practitioners who are not specialists in anesthesiology as long as guidelines for minimizing risks to patients are followed. 1 However, departments of anesthesiology are responsible for providing procedural sedation, 2 including procedural sedation in dentistry. 3 The role of the anesthesiologist in the dental office sedation process includes personally administering an- esthesia, training and supervising nonanesthesiologist providers, looking after the care environment, and pro- moting the quality and safety of care. 2 Procedural sedation delivery varies around the world. There are regions where anesthesiologists are the sole providers of such care in surgery units (e.g., most of Europe), others where a few trained nonanesthesiolo- gists provide sedation in specified circumstances and locations (e.g., the United Kingdom [UK]), and other countries where multiple nonphysician professionals pro- vide sedation in diverse settings (e.g., United States and Canada). 4 In Brazil, anesthesiology is a specialty restricted to physicians. After a 6-yr medical undergraduate course, physicians can apply for a 3-yr anesthesiology residency program. Brazilian law also allows qualified dentists to perform analgesia/sedation and hypnosis. Practitioner skills and practice standards are the general areas of controversy in procedural sedation. 4,5 According to the Joint Commission on Accreditation of Healthcare Organizations, a qualified hospital se- dation provider is one who has “at a minimum had competency-based education, training, and experi- ence” in evaluating patients, performing moderate sedation, and rescuing patients who slip into a deeper- than-desired level of sedation. 6 It has been claimed that a shortage of anesthesiologists is one factor that has limited the expansion of sedation services. 2,5,7 From the *Department of Pediatrics, School of Medicine, and †Faculty of Dentistry, Federal University of Goias, Goiania, Goias, Brazil. Accepted for publication August 13, 2009. Supported by the National Council of Technological and Scien- tific Development (CNPq), Brazil (for the undergraduate student Wilson J. Valadao, Jr.). Reprints will not be available from the author. Address correspondence to Paulo S. S. Costa, MD, PhD, Depart- ment of Pediatrics, Federal University of Goias, Primeira Avenida, sem numero, Setor Universitario, Goiania, Goias 74605-020, Brazil. Address e-mail to plcosta@terra.com.br. Copyright © 2009 International Anesthesia Research Society DOI: 10.1213/ANE.0b013e3181bdc63d Vol. 110, No. 1, January 2010 110