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Copyright (c) 2024 Yahya Ali Mugaddam Khabti, Hind Abdulrahman Ahmed Al-Atiq, Faisal Nawar Al-Harthi, Nawal Mubarak Al-Khudran, Yazeed Ali AlSanie, Muteb Turki Saad Alotaibe, Abdulrahman Abdullah A Alqahtani, Abkar Ali Howash, Eid Mohammed Ahmed Alnami, Nouf Hassan Salman Al-Anazi

This work is licensed under a Creative Commons Attribution 4.0 International License.
Interprofessional Strategies for Enhancing Patient Safety and Reducing Complications in Sedation and Anesthesia for Dental and Head-and-Neck Procedures: Roles of Laboratory Monitoring, Radiological Technology, Nursing, Physiotherapy, Dentistry, and Health
Corresponding Author(s) : Yahya Ali Mugaddam Khabti
Saudi Journal of Medicine and Public Health, Vol. 1 No. 2 (2024)
Abstract
Sedation and anesthesia for dental and head-and-neck procedures take place in shared, anatomically constrained airways, frequently outside conventional operating rooms, and involve pediatric, geriatric, and oncologic patients who carry elevated risk. Complications such as hypoxemia, airway obstruction, aspiration, bleeding, delayed swallowing recovery, and communication failures are often preventable. This narrative review synthesizes evidence published between 2017 and 2025 on interprofessional strategies that strengthen safety, focusing on laboratory monitoring, radiological technology, nursing, physiotherapy, dentistry, and health administration systems. The literature indicates that structured teamwork, standardized monitoring including capnography, risk-stratified preoperative testing, imaging-informed airway planning, early-warning surveillance, prehabilitation and early rehabilitation, and governance that supports training, staffing, and incident learning are the most consistent contributors to risk reduction. An integrated model and implementation priorities are proposed, together with research gaps in outcome measurement, equity, and digital integration.
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- 1. Abbott, T. E. F., Fowler, A. J., Pelosi, P., De Abreu, M. G., Møller, A. M., Canet, J., ... & Johnson, M. (2018). A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. British journal of anaesthesia, 120(5), 1066-1079.
- 2. Ahmad, I., El‐Boghdadly, K., Bhagrath, R., Hodzovic, I., McNarry, A. F., Mir, F., ... & Vaughan, D. (2020). Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia, 75(4), 509-528.
- 3. American College of Radiology. (2015). ACR manual on contrast media. American College of Radiology.
- 4. Andropoulos, D. B. (2018). Effect of anesthesia on the developing brain: infant and fetus. Fetal diagnosis and therapy, 43(1), 1-11.
- 5. Apfelbaum, J. L., Hagberg, C. A., Connis, R. T., Abdelmalak, B. B., Agarkar, M., Dutton, R. P., ... & Tung, A. (2022). 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology, 136(1), 31-81.
- 6. Ashley, P. F., Chaudhary, M., & Lourenço‐Matharu, L. (2018). Sedation of children undergoing dental treatment. Cochrane Database of Systematic Reviews, (12).
- 7. Bates, D. W., & Singh, H. (2018). Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Affairs, 37(11), 1736-1743.
- 8. Boden, I., Skinner, E. H., Browning, L., Reeve, J., Anderson, L., Hill, C., ... & Denehy, L. (2018). Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. bmj, 360.
- 9. Braithwaite, J., Herkes, J., Ludlow, K., Testa, L., & Lamprell, G. (2017). Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ open, 7(11), e017708.
- 10. Collaborative, I. E. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. Washington, DC: Interprofessional Education Collaborative.
- 11. Cook, T. M., & Harrop-Griffiths, W. (2019). Capnography prevents avoidable deaths. BMJ, 364.
- 12. Coté, C. J., Wilson, S., American Academy of Pediatrics, & American Academy of Pediatric Dentistry. (2019). Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics, 143(6), e20191000.
- 13. Dort, J. C., Farwell, D. G., Findlay, M., Huber, G. F., Kerr, P., Shea-Budgell, M. A., ... & Harris, J. (2017). Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA otolaryngology–head & neck surgery, 143(3), 292-303.
- 14. Duggan, E. W., Carlson, K., & Umpierrez, G. E. (2017). Perioperative hyperglycemia management: an update. Anesthesiology, 126(3), 547.
- 15. Gan, T. J., Belani, K. G., Bergese, S., Chung, F., Diemunsch, P., Habib, A. S., ... & Philip, B. K. (2020). Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia, 131(2), 411-448.
- 16. Gelb, A. W., Morriss, W. W., Johnson, W., & Merry, A. F. (2018). World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) international standards for a safe practice of anesthesia. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 65(6), 698-708.
- 17. Gerry, S., Bonnici, T., Birks, J., Kirtley, S., Virdee, P. S., Watkinson, P. J., & Collins, G. S. (2020). Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology. bmj, 369.
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- 20. Homma, Y., Norii, T., Kanazawa, T., Hoshino, A., Arino, S., Takase, H., ... & Japan Society of Procedural Sedation and Analgesia. (2020). A mini‐review of procedural sedation and analgesia in the emergency department. Acute Medicine & Surgery, 7(1), e574.
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- 22. Hutcheson, K. A., Barrow, M. P., Barringer, D. A., Knott, J. K., Lin, H. Y., Weber, R. S., ... & Lewin, J. S. (2017). Dynamic imaging grade of swallowing toxicity (DIGEST): scale development and validation. Cancer, 123(1), 62-70.
- 23. Joffe, A. M., Aziz, M. F., Posner, K. L., Duggan, L. V., Mincer, S. L., & Domino, K. B. (2019). Management of difficult tracheal intubation: a closed claims analysis. Anesthesiology, 131(4), 818.
- 24. Kaasalainen, T., Ekholm, M., Siiskonen, T., & Kortesniemi, M. (2021). Dental cone beam CT: An updated review. Physica Medica, 88, 193-217.
- 25. Khanna, A. K., Bergese, S. D., Jungquist, C. R., Morimatsu, H., Uezono, S., Lee, S., ... & Overdyk, F. J. (2020). Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: an international prospective, observational trial. Anesthesia and analgesia, 131(4), 1012.
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- 27. Klein, A. A., Meek, T., Allcock, E., Cook, T. M., Mincher, N., Morris, C., ... & Young, P. (2021). Recommendations for standards of monitoring during anaesthesia and recovery 2021: Guideline from the Association of Anaesthetists. Anaesthesia, 76(9), 1212-1223.
- 28. Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., ... & Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet global health, 6(11), e1196-e1252.
- 29. Law, J. A., Duggan, L. V., Asselin, M., Baker, P., Crosby, E., Downey, A., ... & Canadian Airway Focus Group. (2021). Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 68(9), 1405-1436.
- 30. Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced recovery after surgery: a review. JAMA surgery, 152(3), 292-298.
- 31. Loh, S. Y., Mcleod, R. W., & Elhassan, H. A. (2017). Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures. European archives of oto-rhino-laryngology, 274(7), 2695-2707.
- 32. Memtsoudis, S. G., Cozowicz, C., Nagappa, M., Wong, J., Joshi, G. P., Wong, D. T., ... & Chung, F. (2018). Society of anesthesia and sleep medicine guideline on intraoperative management of adult patients with obstructive sleep apnea. Anesthesia and analgesia, 127(4), 967.
- 33. Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202.
- 34. Muñoz, M., Acheson, A. G., Auerbach, M., Besser, M., Habler, O., Kehlet, H., ... & Klein, A. A. (2017). International consensus statement on the peri‐operative management of anaemia and iron deficiency. Anaesthesia, 72(2), 233-247.
- 35. Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., ... & Ashcroft, D. M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. bmj, 366.
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- 39. Slawomirski, L., & Klazinga, N. (2022). The economics of patient safety: from analysis to action. OECD Health Working Papers.
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- 41. Warner, D. O., Zaccariello, M. J., Katusic, S. K., Schroeder, D. R., Hanson, A. C., Schulte, P. J., ... & Flick, R. P. (2018). Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: The MASK study. Anesthesiology, 129(1), 89.
- 42. Wiegmann, D. A., Wood, L. J., Cohen, T. N., & Shappell, S. A. (2022). Understanding the “Swiss cheese model” and its application to patient safety. Journal of patient safety, 18(2), 119.
- 43. World Health Organization. (2021). Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. World Health Organization.
References
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2. Ahmad, I., El‐Boghdadly, K., Bhagrath, R., Hodzovic, I., McNarry, A. F., Mir, F., ... & Vaughan, D. (2020). Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia, 75(4), 509-528.
3. American College of Radiology. (2015). ACR manual on contrast media. American College of Radiology.
4. Andropoulos, D. B. (2018). Effect of anesthesia on the developing brain: infant and fetus. Fetal diagnosis and therapy, 43(1), 1-11.
5. Apfelbaum, J. L., Hagberg, C. A., Connis, R. T., Abdelmalak, B. B., Agarkar, M., Dutton, R. P., ... & Tung, A. (2022). 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology, 136(1), 31-81.
6. Ashley, P. F., Chaudhary, M., & Lourenço‐Matharu, L. (2018). Sedation of children undergoing dental treatment. Cochrane Database of Systematic Reviews, (12).
7. Bates, D. W., & Singh, H. (2018). Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Affairs, 37(11), 1736-1743.
8. Boden, I., Skinner, E. H., Browning, L., Reeve, J., Anderson, L., Hill, C., ... & Denehy, L. (2018). Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. bmj, 360.
9. Braithwaite, J., Herkes, J., Ludlow, K., Testa, L., & Lamprell, G. (2017). Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ open, 7(11), e017708.
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11. Cook, T. M., & Harrop-Griffiths, W. (2019). Capnography prevents avoidable deaths. BMJ, 364.
12. Coté, C. J., Wilson, S., American Academy of Pediatrics, & American Academy of Pediatric Dentistry. (2019). Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics, 143(6), e20191000.
13. Dort, J. C., Farwell, D. G., Findlay, M., Huber, G. F., Kerr, P., Shea-Budgell, M. A., ... & Harris, J. (2017). Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA otolaryngology–head & neck surgery, 143(3), 292-303.
14. Duggan, E. W., Carlson, K., & Umpierrez, G. E. (2017). Perioperative hyperglycemia management: an update. Anesthesiology, 126(3), 547.
15. Gan, T. J., Belani, K. G., Bergese, S., Chung, F., Diemunsch, P., Habib, A. S., ... & Philip, B. K. (2020). Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia, 131(2), 411-448.
16. Gelb, A. W., Morriss, W. W., Johnson, W., & Merry, A. F. (2018). World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) international standards for a safe practice of anesthesia. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 65(6), 698-708.
17. Gerry, S., Bonnici, T., Birks, J., Kirtley, S., Virdee, P. S., Watkinson, P. J., & Collins, G. S. (2020). Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology. bmj, 369.
18. Griffiths, P., Recio‐Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., ... & Missed Care Study Group. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of advanced nursing, 74(7), 1474-1487.
19. Halvorsen, S., Mehilli, J., Cassese, S., Hall, T. S., Abdelhamid, M., Barbato, E., ... & Zacharowski, K. (2022). 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC). European heart journal, 43(39), 3826-3924.
20. Homma, Y., Norii, T., Kanazawa, T., Hoshino, A., Arino, S., Takase, H., ... & Japan Society of Procedural Sedation and Analgesia. (2020). A mini‐review of procedural sedation and analgesia in the emergency department. Acute Medicine & Surgery, 7(1), e574.
21. Hosny, A., Parmar, C., Quackenbush, J., Schwartz, L. H., & Aerts, H. J. (2018). Artificial intelligence in radiology. Nature Reviews Cancer, 18(8), 500-510.
22. Hutcheson, K. A., Barrow, M. P., Barringer, D. A., Knott, J. K., Lin, H. Y., Weber, R. S., ... & Lewin, J. S. (2017). Dynamic imaging grade of swallowing toxicity (DIGEST): scale development and validation. Cancer, 123(1), 62-70.
23. Joffe, A. M., Aziz, M. F., Posner, K. L., Duggan, L. V., Mincer, S. L., & Domino, K. B. (2019). Management of difficult tracheal intubation: a closed claims analysis. Anesthesiology, 131(4), 818.
24. Kaasalainen, T., Ekholm, M., Siiskonen, T., & Kortesniemi, M. (2021). Dental cone beam CT: An updated review. Physica Medica, 88, 193-217.
25. Khanna, A. K., Bergese, S. D., Jungquist, C. R., Morimatsu, H., Uezono, S., Lee, S., ... & Overdyk, F. J. (2020). Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: an international prospective, observational trial. Anesthesia and analgesia, 131(4), 1012.
26. Kietaibl, S., Ahmed, A., Afshari, A., Albaladejo, P., Aldecoa, C., Barauskas, G., ... & Zacharowski, K. (2023). Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022. European journal of anaesthesiology, 40(4), 226-304.
27. Klein, A. A., Meek, T., Allcock, E., Cook, T. M., Mincher, N., Morris, C., ... & Young, P. (2021). Recommendations for standards of monitoring during anaesthesia and recovery 2021: Guideline from the Association of Anaesthetists. Anaesthesia, 76(9), 1212-1223.
28. Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., ... & Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet global health, 6(11), e1196-e1252.
29. Law, J. A., Duggan, L. V., Asselin, M., Baker, P., Crosby, E., Downey, A., ... & Canadian Airway Focus Group. (2021). Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 68(9), 1405-1436.
30. Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced recovery after surgery: a review. JAMA surgery, 152(3), 292-298.
31. Loh, S. Y., Mcleod, R. W., & Elhassan, H. A. (2017). Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures. European archives of oto-rhino-laryngology, 274(7), 2695-2707.
32. Memtsoudis, S. G., Cozowicz, C., Nagappa, M., Wong, J., Joshi, G. P., Wong, D. T., ... & Chung, F. (2018). Society of anesthesia and sleep medicine guideline on intraoperative management of adult patients with obstructive sleep apnea. Anesthesia and analgesia, 127(4), 967.
33. Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202.
34. Muñoz, M., Acheson, A. G., Auerbach, M., Besser, M., Habler, O., Kehlet, H., ... & Klein, A. A. (2017). International consensus statement on the peri‐operative management of anaemia and iron deficiency. Anaesthesia, 72(2), 233-247.
35. Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., ... & Ashcroft, D. M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. bmj, 366.
36. Reeves, S., Pelone, F., Harrison, R., Goldman, J., Zwarenstein, M., & Cochrane Effective Practice and Organisation of Care Group. (1996). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane database of systematic reviews, 2018(8).
37. Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433.
38. Schmutz, J. B., Meier, L. L., & Manser, T. (2019). How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ open, 9(9), e028280.
39. Slawomirski, L., & Klazinga, N. (2022). The economics of patient safety: from analysis to action. OECD Health Working Papers.
40. Wall, B. F., Magee, K., Campbell, S. G., & Zed, P. J. (2017). Capnography versus standard monitoring for emergency department procedural sedation and analgesia. Cochrane Database of Systematic Reviews, (3).
41. Warner, D. O., Zaccariello, M. J., Katusic, S. K., Schroeder, D. R., Hanson, A. C., Schulte, P. J., ... & Flick, R. P. (2018). Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: The MASK study. Anesthesiology, 129(1), 89.
42. Wiegmann, D. A., Wood, L. J., Cohen, T. N., & Shappell, S. A. (2022). Understanding the “Swiss cheese model” and its application to patient safety. Journal of patient safety, 18(2), 119.
43. World Health Organization. (2021). Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. World Health Organization.