Anesthesia Rotation - OMFS Perspective

[Yah-E]

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Alright, I found out recenly that most likely I will start my OMFS residency with three months of Anesthesiology rotation when July 1st rolls around. Dental school didn't teach me crap about Anesthesiology so I'm asking for some guidance here.

Are there any pocket reference book(s) that I should get. Currently I'm reading this wonderful site:

http://www.healthsystem.virginia.edu/Internet/Anesthesiology-Elective/

Anything you guys can pass down to me that will be great! 👍

 

[scalpel2008]

Alright, I found out recenly that most likely I will start my OMFS residency with three months of Anesthesiology rotation when July 1st rolls around. Dental school didn't teach me crap about Anesthesiology so I'm asking for some guidance here.

Are there any pocket reference book(s) that I should get. Currently I'm reading this wonderful site:

http://www.healthsystem.virginia.edu/Internet/Anesthesiology-Elective/

Anything you guys can pass down to me that will be great! 👍

These two books are excellent. One is a pocket book, the other is a text. Although you will learn a lot from the anesthesia staff, if you want to read ahead of time, I recommend this. In the Morgan and Mikhail text, read the chapter about the anesthesia machine, just so you know how the circuit, bag, agent cannisters, etc work. Read about the basics on airway management, intubation equipment, etc. Then read about the basic drugs you will be administering on 90% of your cases i.e Fentanyl, Versed, Propofol, Etomidate, Pentothal, Ketamine, Paralytic agents (Succinylcholine, Rocuronium, Pancuronium), Robinul, Inhalation agents (Sevoflurane, Desflurane, isoflurane) etc. emergency drugs. There is no way, no matter how much you read, that you can learn anesthesia just by reading before the rotation, but atleast you'll have an idea.

http://www.amazon.com/gp/product/07...002-9828570-4443234?s=books&v=glance&n=283155

http://www.amazon.com/gp/product/00...8570-4443234?_encoding=UTF8&v=glance&n=283155

 

[LSU-Cowboy]

http://www.amazon.com/gp/product/07...002-9828570-4443234?s=books&v=glance&n=283155

http://www.amazon.com/gp/product/00...8570-4443234?_encoding=UTF8&v=glance&n=283155[/QUOTE]


These are two books i used during anesthesia. Goodstuff. There's another one....small pocketbook that I used....forgot the name....but it's a quick reference to stuff. 90% of the stuff you're gonna learn is from hands on, so don't sweat it.

 

[LSU-Cowboy]

This was my dad's advice when I told him I was on anesthesia (mind you, my dad's a not an MD....he's a resp. therapist):

(When intubating):
Stick it in the top hole because if you put it in the bottom hole it's gonna hurt

 

[Yah-E]

90% of the stuff you're gonna learn is from hands on, so don't sweat it.

Sweet! 5 more days for you my man! After that, we're partying! 👍

 

[Yah-E]

http://www.amazon.com/gp/product/07...002-9828570-4443234?s=books&v=glance&n=283155

http://www.amazon.com/gp/product/00...8570-4443234?_encoding=UTF8&v=glance&n=283155

I, too, heard about the Lange text from medical students.....

Thanks for the info.

 

[MacGyver]

Why would an oral surgery resident need to do an anesthesia rotation?

what purpose would that serve? are you expected to moonlight as an anesthesia provider to other cases when you arent the primary surgeon?

 

[gary_ruska]

Why would an oral surgery resident need to do an anesthesia rotation?

what purpose would that serve? are you expected to moonlight as an anesthesia provider to other cases when you arent the primary surgeon?

Gary Ruska here, ready to help my pal Richard Dean Anderson (personally, I liked you better in Stargate)...

OMFS people administer their own anesthesia for outpatient IV sedations, etc. and, in 43 states in the US, also have general anesthesia certificates. In order to effectively deliver anesthetics, OMFS residents spend about 4 months on the anesthesia service, in most cases at the resident level. This is the amount of time determined by a joint commission of OMFS and people from the ASA.

The subject has been studied and validated as a clinical practice:

1: Rodgers SF.
Safety of intravenous sedation administered by the operating oral surgeon: the first 7 years of office practice. J Oral Maxillofac Surg. 2005 Oct;63(10):1478-83.

2: D'Eramo EM.
Mortality and morbidity with outpatient anesthesia: the Massachusetts
experience. J Oral Maxillofac Surg. 1999 May;57(5):531-6.

3: Perrott DH, Yuen JP, Andresen RV, Dodson TB. Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons.
J Oral Maxillofac Surg. 2003 Sep;61(9):983-95; discussion 995-6.

 

[scalpel2008]

This was my dad's advice when I told him I was on anesthesia (mind you, my dad's a not an MD....he's a resp. therapist):

(When intubating):
Stick it in the top hole because if you put it in the bottom hole it's gonna hurt

I thought "pt" position determines which hole is on top

 

[q8dentist]

to gary_ruska:

do you think that four months of anesthesia rotation is enough to provide GA and IV services?

if the answer is yes then why anesthesia residents spend 3 to 4 years in residency if 4 months is enough ?

i belive that pain control for dental patients is an important but OMF need to spend more time in anesthesia to provide sedation for thier patients.

 

[gary_ruska]

to gary_ruska:

do you think that four months of anesthesia rotation is enough to provide GA and IV services?

if the answer is yes then why anesthesia residents spend 3 to 4 years in residency if 4 months is enough ?

i belive that pain control for dental patients is an important but OMF need to spend more time in anesthesia to provide sedation for thier patients.

Gary Ruska here,
It's not up to you nor Gary Ruska to decide how much time is required to train someone to do sedations. As GR said in his previous post, the guidelines are those established by the AAOMS and the American Society of Anesthesiologists. These same guidelines are used for training Gastroenterologists and Cardiologists to do IV sedations.

Anesthesia residents spend 3-4 years training because they routinely do things much more complicated than IV sedations, which is what the majority of OMFS Anesthsia is. An OMFS will not be expected to administer general anesthesia to patients undergoing cardiac surgery, transplant surgery, multisystem trauma surgery, pregnant patients, etc. OMFS get general anesthesia permits, but GR believes that's because many of the sedation drugs fall under the legal classification of "general anesthetics".

Finally, OMFS residents spend 4 months on an anesthesia service, but administer IV sedations for at least the last two years of their residency as OMFS residents, so the training is certainly much more than 4 months.

 

[toofache32]

Finally, OMFS residents spend 4 months on an anesthesia service, but administer IV sedations for at least the last two years of their residency as OMFS residents, so the training is certainly much more than 4 months.

Toofache here,
This is true. In fact, the Anesthesiology residents do mostly general anesthetics and rarely perform IV sedations. When they do, it's the Fentanyl/Versed type and not the Propofol sedations/GAs that oral surgeons do. Oral surgeons finish training with many times the number of IV sedations under their belts on ASA 1,2, and 3 patients as compared to Anesthesia residents. The safety of this performed by oral surgeons has been documented repeatedly in many studies.

 

[OMFSCardsFan]

to gary_ruska:

do you think that four months of anesthesia rotation is enough to provide GA and IV services?

if the answer is yes then why anesthesia residents spend 3 to 4 years in residency if 4 months is enough ?

i belive that pain control for dental patients is an important but OMF need to spend more time in anesthesia to provide sedation for thier patients.

I'm guessing from your sentence construction that you're a foreigner. What experience do you have with sedation/anesthesia or OMFS residencies? I'm curious what basis you have for holding that opinion...

If you're a dentist or dental student, you do procedures on your patients every day that some people specialize to learn. Does that mean you have to do a four- or six-year OMFS residency to extract a tooth? No, but it means that some OMFS procedures will be out of your realm of expertise. Such will be the case with Endo, Pros, etc. The key to being a good dentist, surgeon, or physician of any kind is knowing when something is in need of services greater than your own. This is why, in some circumstances, an OMFS patient may be taken to the OR (with Anesthesia assistance) for a procedure normally performed in the clinic under sedation.

Please, by all means, tells us more about your "beliefs"...

 

[toofache32]

OMFS anesthesia is predominantly a USA phenomenon. Oral sugeons in other countries generally have no more anesthesia training than ENT/Plastics....which is none.

 

[EuroOMFS]

OMFS anesthesia is predominantly a USA phenomenon. Oral sugeons in other countries generally have no more anesthesia training than ENT/Plastics....which is none.

This is actually true. I'm truly impressed with what you guys learn in your anesthesia rotation and that it's generally accepted that you do your own deep sedations and GAs.

I'm in Denmark, and we do a 3 month anesthesia rotation on our 2nd year (of 5). We basically function on the resident level, although we're not on-call. We learn a lot: intubating, ventilating, administering propofol, sevoflurane, drugs to adjust BP and HR etc., to the point of feeling pretty confident doing those things. Yet, when we're done, thats it. We don't use the stuff ever again. Kinda stupid if you ask me.

As an OMS you do a lot of "minor" procedures, that the patient doesn't necessarily feel are "minor", but can easily be done in local anesthesa with a bit of Versed/Fentanyl IV. That's why it's very logical for OMSs to get training in IV sedation. Not so much for ENTs who mostly do procedures that either require nothing at all (nasal endoscopy) or GA (direct laryngoscopy, laryngeal biopsies, tonsillectomies etc.)

Some of the double-qualified OMSs in Europe get this training, but most of us single-qualified guys don't get it. This of course means that what we can't do with oral sedatives, gets done in GA. The way I see it, our patients are too often put into GA because we can't provide the IV sedation necessary, and the anesthesia service won't provide it, because they're not used to it.

 

[OMFSCardsFan]

This is actually true. I'm truly impressed with what you guys learn in your anesthesia rotation and that it's generally accepted that you do your own deep sedations and GAs.

I'm in Denmark, and we do a 3 month anesthesia rotation on our 2nd year (of 5). We basically function on the resident level, although we're not on-call. We learn a lot: intubating, ventilating, administering propofol, sevoflurane, drugs to adjust BP and HR etc., to the point of feeling pretty confident doing those things. Yet, when we're done, thats it. We don't use the stuff ever again. Kinda stupid if you ask me.

As an OMS you do a lot of "minor" procedures, that the patient doesn't necessarily feel are "minor", but can easily be done in local anesthesa with a bit of Versed/Fentanyl IV. That's why it's very logical for OMSs to get training in IV sedation. Not so much for ENTs who mostly do procedures that either require nothing at all (nasal endoscopy) or GA (direct laryngoscopy, laryngeal biopsies, tonsillectomies etc.)

Some of the double-qualified OMSs in Europe get this training, but most of us single-qualified guys don't get it. This of course means that what we can't do with oral sedatives, gets done in GA. The way I see it, our patients are too often put into GA because we can't provide the IV sedation necessary, and the anesthesia service won't provide it, because they're not used to it.

It would irritate the crap out of me to be minus the intermediate step between local and GA. There are a ton of procedures that seem a little too "simple" to warrant GA, but I would not want to experience with only local. FMX, alveolo, minor pathology, etc. Do you all use Nitrous?

 

[EuroOMFS]

It would irritate the crap out of me to be minus the intermediate step between local and GA. There are a ton of procedures that seem a little too "simple" to warrant GA, but I would not want to experience with only local. FMX, alveolo, minor pathology, etc. Do you all use Nitrous?

I know, it irritates me like hell! We sometimes use nitrious oxide, it depends on the hospital. I used it a lot before I entered recidency, when doing dental work on young children. We mostly use oral sedatives, triazolam, midazolam, some use diazepam. They work, of course, but have unpredictable effect (work well on some, not quite so well on others).