All Emergencies - Basic life support principles:

  1. Maintain an airway
  2. Assess breathing
  3. Monitor circulation
Monitor and record all vital signs.
Respiratory Depression


  1. Often secondary to administration of CNS depressant drugs
  2. Decreased rate of respiration &/or decreased ventilatory effort



  1. Terminate dental treatment.
  2. Place patient in supine position.
  3. A-B-C Airway, Breathing, Circulation - Basic life support, as indicated.
  4. Monitor BP, heart rate & rhythm every 5 minutes.
  5. Administer oxygen.
  6. Start IV infusion if not already present.
  7. Antidotal drugs can be used, though not usually necessary:
    • When opioids have been administered, give naloxone - adults - 0.1 mg/min until improved ventilation noted.
    • When benzodiazepines have been administered, give flumazenil - adults - 0.2 mg/min until improved ventilation is seen.
    • When barbiturates have been administered, no antagonist exists. Continue assisted ventilation until spontaneous breathing returns.
  8. Recovery: It may be possible to continue dental treatment if respiratory depression was brief. If problem was prolonged, it may be necessary to end planned treatment.
  9. Discharge the patient to a responsible adult if the doctor believes patient's recovery is adequate. Outside medical assistance rarely required.

Source: Sedation, A Guide to Patient Management by Stanley F. Malamed