Pediatric Dental Office Anesthesia

[stonemd]

Our group currently provides adult sedation in dental offices.
We currently provide general anesthesia for pediatric dental in our ambulatory surgery center.
We are now requested to provide pediatric 'anesthesia' in their office
mostly because some self pay families cannot afford anesthesiologist fee + ASC facility fees

I see that others in our state are providing sedation and general anesthesia for this

My questions for those providing office pediatric dental
do you use sedation or general anesthesia?
do you start peds IV with preop with sedation (nitrous/versed/EMLA) or volatile induction?
do you have a anesthesia machine (vaporizer/ventilator)?
if you keep volatile agent or sux at the office, do you keep dantrolene?
does the dentist provide any equipment/supplies/medicines or do you bring it all?
for general anesthesia do you primarily use tracheal tube or supra-glottic airway?
do you use an assistant (RN, critical care RN ...)?

i know many want to respond "don't do it, not safe..."
but this is happening all over the country
by office physician anesthesiologists
and dentist anesthesiologists
so if we don't provide this, others will.

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[ProwlerturnGas]

This is my current gig, anesthesia for peds dentists-in office.

We use general anesthesia, sevo induction, IV start, intubate nasally with Rae tube. Change from gas to TIVA.
No ventilator. If kid needs ventilation, you are it--which is very rare. Try to keep them spontaneous.
Sux on hand for emergency only. We do carry dantrolene
No assistant, You are the PACU nurse as well LOL

Don't let anyone tell you its not safe. It IS very safe. You have to realize that you are IT in the office setting and be comfortable. Our group takes many precautions to make it safe. Our group is growing and we are very busy. We have now over 12K kids successfully anesthetized.

 

[IlDestriero]

I would not do that job without a nurse with PACU training to recover the patients while you are not available doing the next child. Not a chance. I do ASC cases solo, but there are experienced PACU nurses in recovery and other physicians in the building if a patient arrested.
Do you use one of the portable anesthesia machines that the military uses, or did you rig some spare parts junk heap together like that nut that puts posters up at all the meetings.
(Apologies if that's you...)

 

[ProwlerturnGas]

Oh Brother Anyone who has serious questions, feel free to PM

 

[risnwb]

Oh Brother Anyone who has serious questions, feel free to PM

How do you make it financially viable If you are also recovering the kid? Seems like even with the most rapid wakeup, the kid isn't leaving in less than 30 mins after case is over...

 

[Precedex]

Wow. What percentage of kids need all this? I have family in pediatric dentist and it is extremely rare that they need to use GA (ie referral because they don't do this at the office). So by far most need nothing, some might get nitrous or po versed. I do GAs for pedi Dental in the childrens hospital but these are kids that have failed sedation a few times usually with tons of stuff going on, definitely not the routine.

This is my current gig, anesthesia for peds dentists-in office.

We use general anesthesia, sevo induction, IV start, intubate nasally with Rae tube. Change from gas to TIVA.
No ventilator. If kid needs ventilation, you are it--which is very rare. Try to keep them spontaneous.
Sux on hand for emergency only. We do carry dantrolene
No assistant, You are the PACU nurse as well LOL

Don't let anyone tell you its not safe. It IS very safe. You have to realize that you are IT in the office setting and be comfortable. Our group takes many precautions to make it safe. Our group is growing and we are very busy. We have now over 12K kids successfully anesthetized.

 

[Sublimazing]

Wow. What percentage of kids need all this? I have family in pediatric dentist and it is extremely rare that they need to use GA (ie referral because they don't do this at the office). So by far most need nothing, some might get nitrous or po versed. I do GAs for pedi Dental in the childrens hospital but these are kids that have failed sedation a few times usually with tons of stuff going on, definitely not the routine.

The easier the peds dentist has access to in office GA the more they'll use it. It's very lucrative for the peds dentist to keep this stuff in house...if theyre not using it, it's because they don't know they can, or no one has offered.

 

[Hoya11]

This is my current gig, anesthesia for peds dentists-in office.

We use general anesthesia, sevo induction, IV start, intubate nasally with Rae tube. Change from gas to TIVA.
No ventilator. If kid needs ventilation, you are it--which is very rare. Try to keep them spontaneous.
Sux on hand for emergency only. We do carry dantrolene
No assistant, You are the PACU nurse as well LOL

Don't let anyone tell you its not safe. It IS very safe. You have to realize that you are IT in the office setting and be comfortable. Our group takes many precautions to make it safe. Our group is growing and we are very busy. We have now over 12K kids successfully anesthetized.

how are you giving sevo via vaporizer with no ventilator/anesthesia machine?
i also wonder about the PACU time - you are probably billing for that time right? but i would think they need at least 30 mins to recover, sometimes an hour, how many cases do you typically do a day with this system?

 

[Consigliere]

Oh Brother Anyone who has serious questions, feel free to PM

Barry Friedman redux.

 

[IlDestriero]

how are you giving sevo via vaporizer with no ventilator/anesthesia machine?
i also wonder about the PACU time - you are probably billing for that time right? but i would think they need at least 30 mins to recover, sometimes an hour, how many cases do you typically do a day with this system?

Maybe he is that guy with the spare parts machine? Has anyone else seen his demo and posters? It's scary.
I imagine he has one of these http://www.obamed.com/Features.html
And a transport monitor with CO2.

 

[urge]

how are you giving sevo via vaporizer with no ventilator/anesthesia machine?
i also wonder about the PACU time - you are probably billing for that time right? but i would think they need at least 30 mins to recover, sometimes an hour, how many cases do you typically do a day with this system?

Huh?

It's all cash. All that matters is a good outcome, not paperwork or billing.

 

[urge]

This is my current gig, anesthesia for peds dentists-in office.

We use general anesthesia, sevo induction, IV start, intubate nasally with Rae tube. Change from gas to TIVA.
No ventilator. If kid needs ventilation, you are it--which is very rare. Try to keep them spontaneous.
Sux on hand for emergency only. We do carry dantrolene
No assistant, You are the PACU nurse as well LOL

Don't let anyone tell you its not safe. It IS very safe. You have to realize that you are IT in the office setting and be comfortable. Our group takes many precautions to make it safe. Our group is growing and we are very busy. We have now over 12K kids successfully anesthetized.

Very impressive.

Is the post of child within your line of sight when you are taking care of the next one?

 

[gasdoc77]

How about opening a dental practice and hiring dentists as employees? We could then do the anesthesia when/as we saw fit. That's the kind of s/$t other fields do. Create 2 revenue streams.