Another Pediatric Fatality

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Xigris14

Xigris14

Full Member
10+ Year Member
15+ Year Member
Joined
Jan 8, 2008
Messages
85
Reaction score
14
Now a dentist doing root canals in Hawaii on a child I believe age 3 dies after anoxic brain injury/cardiac arrest. Sedation of course was given. It appears it took an excessive long time to even notice a problem was occurring and then another doctor had to be brought in to assist in CPR? Again this is all just coming from the News not facts.

This is just me venting to dentist who want to sedate patients. This is real. Not a joke. You have to be ready for every emergency and know how to sedate kids. They crash hard and go down quicker then adults. Im a oral surgeon and I will not sedate kids probably younger then 8 or 9 because its not worth it. My career cost a lot of money. My family relies on my career. My reputation is my career and I am not going to take a risk on some little kid so I can accommodate that patient in my office. That's why there are hospitals and surgery centers. Folks I am very confident in my sedation skills but I know when to watch out and with kids you cant just push meds and keep pushing to your desired level of sedation.

Now there is a child dead which probably could have been prevented. I fell sorry for that child and family.
That dentist career is over and is being sued. Life forever changed.
More scrutiny on dentist and oral surgeon with in office sedation.

Folks get ready, the days of sedating in your office without a licensed anesthesia personal are going to end and this will come faster because of these incidents. I'm not saying OMFS are perfect and blaming dentist. I'm just sending out a broad message to all that choose to sedate via oral or IV manners.
Members don't see this ad.
 
Last edited:
Xigris14 said:
Now a dentist doing root canals in Hawaii on a child I believe age 3 dies after anoxic brain injury/cardiac arrest. Sedation of course was given. It appears it took an excessive long time to even notice a problem was occurring and then another doctor had to be brought in to assist in CPR? Again this is all just coming from the News not facts.

This is just me venting to dentist who want to sedate patients. This is real. Not a joke. You have to be ready for every emergency and know how to sedate kids. They crash hard and go down quicker then adults. Im a oral surgeon and I will not sedate kids probably younger then 8 or 9 because its not worth it. My career cost a lot of money. My family relies on my career. My reputation is my career and I am not going to take a risk on some little kid so I can accommodate that patient in my office. That's why there are hospitals and surgery centers. Folks I am very confident in my sedation skills but I know when to watch out and with kids you cant just push meds and keep pushing to your desired level of sedation.

Now there is a child dead which probably could have been prevented. I fell sorry for that child and family.
That dentist career is over and is being sued. Life forever changed.
More scrutiny on dentist and oral surgeon with in office sedation.

Folks get ready, the days of sedating in your office without a licensed anesthesia personal are going to end and this will come faster because of these incidents. I'm not saying OMFS are perfect and blaming dentist. I'm just sending out a broad message to all that choose to sedate via oral or IV manners.
Click to expand...
Just curious, what are your thoughts on GPs doing IV? I personally don't do it and don't want to take the risk, but there are GPs who it very liberally. I even know someone who it for a filling or two.
 
Members don't see this ad :)
The Peds ED residents brought this up tonight on my rotation... they definitely did not look fondly on dentists doing sedation. I do not think physicians (much less the general public) understand that OMFS residents spend a minimum of 5 months on anesthesia, unlike other dentists (sans dental anesthesiologists). Unfortunately I have to agree with you Xigris that stories like these will soon ruin the single operator-anthesthetist model.
 
The sedation standards by which most dentists abide are woefully inadequate. They should hire a CRNA to perform the sedation. Safer for the patient and your reputation. I don't think a dentist should ever be performing a procedure AND a sedation at the same time. This discussion took place over on the anesthesia forum awhile back and that was their take. I agree. The single-operator anesthetist model that most oral surgeons employ is done to increase their income. Unfortunately, it is done at the expense of patient safety. The incidence of adverse events (as they are so euphemistically called) is low among oral surgeons providing their own anesthesia, but it is still safer to have a separate operator (a separate brain) focusing on the patient's anesthesia, airway, and reactions. It's practically unheard of elsewhere to have a surgeon managing the anesthesia and performing a procedure at the same time.
 
Last edited:
Agree w/ OP. Unless you're a trained oral surgeon/ dent anes, you have NO BUSINESS doing IV sedations OPGA. I'd venture 99% of these guys have never seen or managed an emergency, yet they want to push meds. Shhh, even as a OMFS there are certain cases that are best suited in a surg center, case selection and the ability identify red flags is not something you get over 13 hrs.
 
Silent Cool said:
The sedation standards by which most dentists abide are woefully inadequate. They should hire a CRNA to perform the sedation. Safer for the patient and your reputation. I don't think a dentist should ever be performing a procedure AND a sedation at the same time. This discussion took place over on the anesthesia forum awhile back and that was their take. I agree. The single-operator anesthetist model that most oral surgeons employ is done to increase their income. Unfortunately, it is done at the expense of patient safety. The incidence of adverse events (as they are so euphemistically called) is low among oral surgeons providing their own anesthesia, but it is still safer to have a separate operator (a separate brain) focusing on the patient's anesthesia, airway, and reactions. It's practically unheard of elsewhere to have a surgeon managing the anesthesia and performing a procedure at the same time.
Click to expand...


Physicians are so insulated from cost. They can spout off all they want about "just bring in another doctor" "bring in a CRNA". The reality is there is no money for this in most markets. The patients pay for their own sedation in dentistry. Let's just agree to return back to papoose boards and step back 30 years where everyone is actually afraid of the dentist. Or lets bankrupt the medicaid programs by bringing every filling to the OR. We could also just limit our access to anesthesia just to rich people who can afford an anesthesiologist. Or you anesthesiologists can show up at my office for my $300/sedation I can charge. You bring your drugs, supplies, rescue kits, pacu nurse, pay your insurance, do your own drug audits, preop them, call their PCP, and call my patient that night to see how they are doing. And you'll have 1 sedation at 730am, 10am, and 1 at 3pm. That is my schedule because that is what my patient's need. No takers.

Sedation and proceduralist is not limited to just dentistry. Endoscopy sedation is often done by the GI doc. Sometimes directing an RN (Not a crna). ER physicians are commonly required to sedate and do a fast procedure because to wait for anesthesia to come in is cruel or to transfer is a waste of money and the patient's time. Plastic surgeons push sedation for their simple in office procedures. Just like us, once they get good local, almost no sedation required. Lots of examples.

Lastly, sedation by oral surgeon does not directly substantially increase income after unit costs, buildouts, time, risk, etc. It absolutely does allow for a very pleasant procedure that often commands a high fee. So you are correct. When an oral surgeon does some 3rds or implants or small biopsy on a previously nervous patient who goes home smiling and laughing and they barely remember the IV even going in, you bet that is worth a bunch of money.
 
Silent Cool said:
The sedation standards by which most dentists abide are woefully inadequate. They should hire a CRNA to perform the sedation. Safer for the patient and your reputation. I don't think a dentist should ever be performing a procedure AND a sedation at the same time. This discussion took place over on the anesthesia forum awhile back and that was their take. I agree. The single-operator anesthetist model that most oral surgeons employ is done to increase their income. Unfortunately, it is done at the expense of patient safety. The incidence of adverse events (as they are so euphemistically called) is low among oral surgeons providing their own anesthesia, but it is still safer to have a separate operator (a separate brain) focusing on the patient's anesthesia, airway, and reactions. It's practically unheard of elsewhere to have a surgeon managing the anesthesia and performing a procedure at the same time.
Click to expand...

Agreed, undoubtedly the motivation for a lot of dentists doing IV is the $$$. I read somewhere that a GP doing IV over the course of his career can add something like 750k to his earnings. However, I think with the medications in IV sedation as well as the serious risks in airway maintainence I simply don't think it's worth it. I just find it appalling that so many GPs do it so freely. The guy that I mentioned in my post above do it for regular fillings.
 
Op, great thoughts. So maybe you could talk to your OMFS counterparts and get them to support the recognition of dental anesthesiology as a specialty?
 
FWIW, the dentist was NOT a pediatric dentist, thus did not have sedation training that is consistent with training received at a Pediatric residency. The patient was given ORAL demerol, Hydroxyzine, and Chloral Hydrate. Probably another reason most pediatric dentists do not do oral sedation with Chloral anymore.
 
California requires proof of training and issues permits for all forms of office dental sedation/anesthesia. General anesthesia, conscious IV sedation, pediatric oral conscious sedation, adult ora conscious sedation. What does Hawaii require? CODA in their standards for pediatric dental training require 50 sedation cases(of which only 25 are as primary provider) plus 1 month hospital dental anesthesia rotation. Are pediatric dentists being inadequately trained? Perhaps CODA should up their requirements and adequate train pediatric dentists. Training....Training...Training! It seems to me that if Hawaii were requiring the same standards as California, this case would not have occurred. Here is the requirements in California for those providing oral conscious sedation for both adults and children:

Section 1044.5. Facility and Equipment Standards.
A facility in which oral conscious sedation is administered to patients pursuant to this article shall meet the standards set forth below.
(a) Facility and Equipment.

  1. (1) An operatory large enough to adequately accommodate the patient and permit a team consisting of at least three individuals to freely move about the patient.
  2. (2) A table or dental chair which permits the patient to be positioned so the attending team can maintain the airway, quickly alter patient position in an emergency, and provide a firm platform for the management of cardiopulmonary resuscitation.
  3. (3) A lighting system which is adequate to permit evaluation of the patient's skin and mucosal color and a backup lighting system which is battery powered and of sufficient intensity to permit completion of any treatment which may be underway at the time of a general power failure.
  4. (4) An appropriate functional suctioning device that permits aspiration of the oral and pharyngeal cavities. A backup suction device that can function at the time of general power failure must also be available.
  5. (5) A positive-pressure oxygen delivery system capable of administering greater than 90% oxygen at a 10 liter/minute flow for at least sixty minutes (650 liter "E" cylinder), even in the event of a general power failure. All equipment must be age-appropriate and capable of accommodating the patients being seen at the permit-holder's office.
  6. (6) Inhalation sedation equipment, if used in conjunction with oral sedation, must have the capacity for delivering 100%, and never less than 25%, oxygen concentration at a flow rate appropriate for an age appropriate patient's size, and have a fail-safe system. The equipment must be maintained and checked for accuracy at least annually.
(b) Ancillary equipment, which must include the following, and be maintained in good operating condition:

  1. (1) Age-appropriate oral airways capable of accommodating patients of all sizes.
  2. (2) An age-appropriate sphygmomanometer with cuffs of appropriate size for patients of all sizes.
  3. (3) A precordial/pretracheal stethoscope.
  4. (4) A pulse oximeter.
(c) The following records shall be maintained:

  1. (1) An adequate medical history and physical evaluation, updated prior to each administration of oral conscious sedation. Such records shall include, but are not limited to, an assessment including at least visual examination of the airway, the age, sex, weight, physical status (American Society of Anesthesiologists Classification), and rationale for sedation of the minor patient as well as written informed consent of the patient or, as appropriate, parent or legal guardian of the patient.
  2. (2) Oral conscious sedation records shall include baseline vital signs. If obtaining baseline vital signs is prevented by the patient's physical resistance or emotional condition, the reason or reasons must be documented. The records shall also include intermittent quantitative monitoring and recording of oxygen saturation, heart and respiratory rates, blood pressure as appropriate for specific techniques, the name, dose and time of administration of all drugs administered including local and inhalation anesthetics, the length of the procedure, any complications of oral sedation, and a statement of the patient's condition at the time of discharge.
(d) An emergency cart or kit shall be available and readily accessible and shall include the necessary and appropriate drugs and age- and size-appropriate equipment to resuscitate a nonbreathing and unconscious patient and provide continuous support while the patient is transported to a medical facility. There must be documentation that all emergency equipment and drugs are checked and maintained on a prudent and regularly scheduled basis. Emergency drugs of the following types shall be available:

  1. (1) Epinephrine
  2. (2) Bronchodilator
  3. (3) Appropriate drug antagonists
  4. (4) Antihistaminic
  5. (5) Anticholinergic
  6. (6) Anticonvulsant
  7. (7) Oxygen
  8. (8) Dextrose or other antihypoglycemic
 
Members don't see this ad :)
This was a terrible tragedy. However, simultaneously this could of very easily been avoided and ironically very difficult to avoid.
First of all, I agree, the reason to do this in a hospital setting is in case of things not going correctly. Patients die under general anesthesia from a slew of different reasons. Even if everything was performed perfectly, this tragedy could have happened to anyone. That is why in the hospital setting, faster emergent life saving capabilities may have saved her life.
On the other side, this specific dentist was grossly negligent. She delivered overdose levels of medication, did not properly monitor the patient, and did not properly respond to the emergent situation. Shame on her and may the little girl rest in peace.
Experience and proper education are the most important in general anesthesia and sedation. I have seen negligent behavior from OMFS's and seen top notch provision of care by general dentists. So let not the OFMS snub their noses at perceived lesser qualified practitioners. Both can be excellent and both can be terrible.
Just last month the State of North Carolina has its first dental patient fatality in 30 years. It was the same situation; patient under sedation stopped breathing because of overdose levels of drug, the Dr failed to properly monitor and respond. The patient died.
Remember my fellow colleagues, " Do no harm first".

-t00th d0c
 
Shunwei said:
Just curious, what are your thoughts on GPs doing IV? I personally don't do it and don't want to take the risk, but there are GPs who it very liberally. I even know someone who it for a filling or two.
Click to expand...



I don't mind anyone doing sedation as long as they are properly trained. The problem we have is "What is properly trained" Now I agree OMFS training and Dental Anesthesia is proper training. But I don't agree with these courses for GP that are marketed for "get rich schemes". How can someone take a couse 1 week or 2 weeks long and come out saying I am ready to sedate and handle all emergencies? No way. I would love to see these courses go away and I don't understand how they still exist.

I also agree with the rule of a CRNA to manage anesthesia while the surgeon operates. I would like to see this happen in all setting dental and medical.

This is what will happen.
1) These cases give credit to anesthesia world and politics to get rid of surgeon/dentist doing the work and sedating at the same time. First it will effect the GP then the OMFS. We will all fight to protect our ability to sedate and operate but in the end these cases will be overwhelming proof that a CRNA is required.
2) Insurance will have sedation part of the procedure like how medicare is doing it now. Example: If I do a biopsy on a patient with medicate and i sedate, then I can't bill for sedation and the procedure. Its all lumped in one. No financial incentive for sedation. Will probably have to pay a CRNA a salary.
3) Dental and Medical plans will be dropped by OMFS and dentist as reimbursement decreases and when these other insurances start to pick up on this sedation/procedure lumped in one bill. Fee for service will be seen as the only option with maybe one or two awesome insurances.
4) There will always be OMFS and dental offices that accept all insurances but they will be overwhelmed and have to increase their patient numbers to accommodate the decreased reimbursement similar to what is going on in our medical community. Thus the rich get the best treatment and doctors and the middle class and poor get the long lines/waits and treated like cattle in these mill like offices.

My 2 cents. I have been in practice for over 5 years. I know whats going on. Mark my word.
 
Sure...if we all go down that road there will also be no CRNA's. Many states are creating Anesthesia Assistants on the model of Surgical Physician Assistants. So the person giving the GA will be an AA not even a trained nurse. How would you like someone giving anesthesia with only 6 months training? That is a very very dangerous road to go down. And if you think that is going to happen better gear up the lobbying because that is not in anyone's best interest.

There is nothing wrong with the model of the operater delivered moderate/deep sedation as has been proven in the OMS office, in colonoscopy, in endoscopy procedures. Training and regulation is the key here.

How in the world did Hawaii allow this to be unregulated? If this dentist was indeed not even a pediatric dental specialist and just someone hanging out a shingle proporting to be one, then the onus of this problem is with the State of Hawaii and their licensing and regulatory board.
 
drgoro said:
Agree w/ OP. Unless you're a trained oral surgeon/ dent anes, you have NO BUSINESS doing IV sedations OPGA. I'd venture 99% of these guys have never seen or managed an emergency, yet they want to push meds. Shhh, even as a OMFS there are certain cases that are best suited in a surg center, case selection and the ability identify red flags is not something you get over 13 hrs.
Click to expand...

The practice my father used to work at runs a yearly course on IV sedation. It's two 3-day weekends long, one of didactic training and one practical. During the practical week they do around 8-10 IV starts and fentanyl/versed sedations. Almost forgot, they have to intubate a mannequin. As far as I understand, this course has a coast-wide draw and is considered one of the "better" IV sedation courses.

Zero real world airway management, zero experience with anesthetic emergencies, no real experience in case selection and of course, zero pediatric experience. There's some good studies in the emergency medical services literature that even trained practitioners can lose their airway skills if they don't frequently practice them. If this is the baseline for training dentists in IV anesthetics, I'm wholly surprised there haven't been more deaths.
 
This is a very unfortunate event and hopefully one that will force all of us (dentistry) to critically examine sedation/anesthesia guidelines.

I would also like to disclose that I am a pediatric dentist and I am currently in a dental anesthesia residency. Furthermore, in private practice (2 years) I completed hundreds of oral conscious sedation for my pediatric patients. A good portion of the time, I selected the same medications (Chloral Hydrate, Demerol, Hydroxyzin) to sedate my patients which were used for the child in Hawaii.


Just would like to make a few points

#1. From reading this thread I get the impression that many people look down upon IV sedation by the GP. Just to clarify, this child died from an ORAL med sedation and the two recent adult deaths in North Carolina (there have been two deaths, not one) also died from an ORAL med sedation. I believe anyone with experience with anesthesia would tell you it is much safer to titrate meds to a sedation level then by guessing with an oral dose/redoses. IV access also allows someone trained in anesthesia instant access to give emergency meds.

#2. I agree with a few posters that the medical model of anesthesia (separate surgeon and anesthesia provider) is inherently safer than operating as both the surgeon/anesthesia provider. However, I would argue that many fields of dentistry and medicine have shown a relatively safe history of operating as both: GI docs, Oral Surgery, Pediatric Dentistry, etc. Could this be improved by using the medical model? Sure, absolutely, but unfortunately things come down to cost. Who pays this increased cost and at what point should we try to control health care costs? Should we improve training, increase requirements, eliminate dual operator model? I would argue to increase training and experience with emergencies, but this is still to be decided.

#3. Not all states allow CRNAs to practice independently in a dental office. Thus, this is not an option for everyone.

#4. I work with AAs (Anesthesia Assistants) in my hospital and personally think they are very qualified anesthesia providers. I would like to remind everyone it is not the degree or training that proves someone’s skill or competence. There are good and bad providers in every field. Finally, an AAs training consists of 24 to 28 months of anesthesia training (both clinical and didactic), not six months like previously mentioned.

#5. I believe the six months that one poster mentioned is actually referencing Oral Surgery’s program to qualify dental assistants to push drugs and monitor the patient while the oral surgeon acts as both surgeon and anesthesia provider (what has recently come under scrutiny in Oklahoma). These qualifications are 36 hours of CE. I will leave it up to each individual to decide if this is sufficient training to push anesthesia medications, monitor the patient, and assist in case of emergency. Below is a link to the DAANCE (Dental Anesthesia Assistant National Certification Examination) website.
http://www.aaoms.org/members/meetings-and-continuing-education/certification-program-daance/

#6. I would like to clarify the use of the term “overdose’. The Hawaii girl and the North Carolina patients suffered a terrible outcome, ultimately, due to a failure to recognize a patient who had lost their airway (either due to apnea, or some kind of obstruction) not due to overdose. Did this dose of meds cause this loss of airway? Sure it did, but each patient responds differently to medications. Thus, you can never be sure when this threshold will be reached.

#7. Some believe that this patient died because she was cared for by a general dentist and not a pediatric dentist. No doubt pediatric dentists have more experience and knowledge of the pediatric patient and sedation with the pediatric patient. However, as I have mentioned before, your degree or certificate does not make you qualified. It is your knowledge, clinical skill, and experience. I personally know several pediatric dentists and general dentists who I would trust with sedating a loved one of mine. However, I also know many pediatric dentists and general dentists who I would never trust with this responsibility. My point is that just going to pediatric residency does not automatically mean this outcome would have been different. Do you think 50 sedations, 25 as primary operator, and one month of anesthesia rotation qualify you to rescue a child who has lost their airway? I would say an emphatic no. However, I will say that this training does instill a much deeper respect/fear of anesthesia and generally a greater ability to recognize a situation that is becoming emergent. By the way, the requirement of 50 sedation experiences was just recently increased in the past few years from 25 or 20.


I am not trying to step on toes or talk down about any group of providers. I think in general we are going toward stricter requirements for sedation, and I personally believe this will eventually lead to the elimination of CE courses that qualify you for a sedation/anesthesia permit. You will only be able to get this through a residency. We should all strive for our profession to never harm a patient and to maintain our ability to self-govern anesthesia in dentistry.
 
Gee I thought the point of this thread was about ORAL sedation and lack of training , qualification, or regulation. How did this stuff about IV sedation creep in?
Some other points…

1. Is there some reason pedo residencies do not give adequate anesthesia training? Why do pedo people have to do an anesthesia residency to gain any this expertise? 50 cases of sedation (of which only 25 are required as primary provider) is woeful. Particularly when you consider the patient demographic (pediatric patients which are inherently high risk). Perhaps pedo should add a third year and have more real anesthesia training. I have seen many pediatric dentists abrogate their ability to do sedation by hiring dental anesthesiologists. Why does pediatric dentistry ignore or abrogate this portion of their speciality?

2. On the model of a separate anesthesia provider being safer….it was not the case in the recent Maryland death in a OMS office where the anesthesia provider was a separate MD anesthesiologist. The solo anesthesia/surgeon works well (ER medicine, gastrointerology, OMS) provided one has the training and the procedure is relatively short and serves patient's needs both safely and economically.

3. There are oral sedation protocols out there that are pretty scary (ever see the DOCS protocol using ambien and lorazepam?). Obviously these protocols need to be regulated and monitored and proper training required. Unlike apparently what happened in Hawaii

4. Do not forget…since we are all non-MD providers of anesthesia services, we are all in the same boat as are CRNA's (who can have some modicum of independent practice) unlike AA's who are medically directed.

5. An addendum to #1 above, why isn't there more outrage from organized Pediatric Dentistry about the qualification (or lack thereof) by the dentist in this Hawaii case? Again the onus is on the State of Hawaii for not proper regulation and inspection.
 
GTFOOMICT said:
Physicians are so insulated from cost. They can spout off all they want about "just bring in another doctor" "bring in a CRNA". The reality is there is no money for this in most markets. The patients pay for their own sedation in dentistry. Let's just agree to return back to papoose boards and step back 30 years where everyone is actually afraid of the dentist. Or lets bankrupt the medicaid programs by bringing every filling to the OR. We could also just limit our access to anesthesia just to rich people who can afford an anesthesiologist. Or you anesthesiologists can show up at my office for my $300/sedation I can charge. You bring your drugs, supplies, rescue kits, pacu nurse, pay your insurance, do your own drug audits, preop them, call their PCP, and call my patient that night to see how they are doing. And you'll have 1 sedation at 730am, 10am, and 1 at 3pm. That is my schedule because that is what my patient's need. No takers.

Sedation and proceduralist is not limited to just dentistry. Endoscopy sedation is often done by the GI doc. Sometimes directing an RN (Not a crna). ER physicians are commonly required to sedate and do a fast procedure because to wait for anesthesia to come in is cruel or to transfer is a waste of money and the patient's time. Plastic surgeons push sedation for their simple in office procedures. Just like us, once they get good local, almost no sedation required. Lots of examples.

Lastly, sedation by oral surgeon does not directly substantially increase income after unit costs, buildouts, time, risk, etc. It absolutely does allow for a very pleasant procedure that often commands a high fee. So you are correct. When an oral surgeon does some 3rds or implants or small biopsy on a previously nervous patient who goes home smiling and laughing and they barely remember the IV even going in, you bet that is worth a bunch of money.
Click to expand...

It just means that instead of the dentist/OMS collecting the sedation fee, the anesthesiologist/CRNA will collect it or most of it.
 
Doc Ock II said:
Gee I thought the point of this thread was about ORAL sedation and lack of training , qualification, or regulation. How did this stuff about IV sedation creep in?
Some other points…

1. Is there some reason pedo residencies do not give adequate anesthesia training? Why do pedo people have to do an anesthesia residency to gain any this expertise? 50 cases of sedation (of which only 25 are required as primary provider) is woeful. Particularly when you consider the patient demographic (pediatric patients which are inherently high risk). Perhaps pedo should add a third year and have more real anesthesia training. I have seen many pediatric dentists abrogate their ability to do sedation by hiring dental anesthesiologists. Why does pediatric dentistry ignore or abrogate this portion of their speciality?
Click to expand...

On top of the sedation-specific training, pediatric dentistry residencies also require training in general anesthesia. I worked in the OR with the anesthesia team, performing intubations, IV's, bag-masking, etc. for a month.
 
sarah_bellum said:
On top of the sedation-specific training, pediatric dentistry residencies also require training in general anesthesia. I worked in the OR with the anesthesia team, performing intubations, IV's, bag-masking, etc. for a month.
Click to expand...

Gee, a whole month, huh? :laugh::scared:
 
Silent Cool said:
Gee, a whole month, huh? :laugh::scared:
Click to expand...
The point, of course, is that the described amount of experience was not correct for training. If you're going to debate the quality of the training, critique it based on the actual experience.

The goal of the training isn't to be proficient in administering general anesthesia, but maintaining an airway.

What's a reasonable amount of training for someone administering oral sedation in children? As far as I'm concerned, it's all about case selection and knowing your limits. Oral sedation is incredibly safe when managed by competent providers on healthy kids.
 
Last edited:
sarah_bellum said:
The point, of course, is that the described amount of experience was not correct for training. If you're going to debate the quality of the training, critique it based on the actual experience.

The goal of the training isn't to be proficient in administering general anesthesia, but maintaining an airway.

What's a reasonable amount of training for someone administering oral sedation in children? As far as I'm concerned, it's all about case selection and knowing your limits. Oral sedation is incredibly safe when managed by competent providers on healthy kids.
Click to expand...

The point is that a separate operator should be managing the sedation/airway. The one month you received is more like....exposure, rather than training. Especially because most of your daily focus as a dentist is teeth, not sedation/airway.
 
Silent Cool said:
The point is that a separate operator should be managing the sedation/airway.
Click to expand...

That point is based on what....just your personal opinion? I respect your opinion, but statistics say it is very safe in the OMS community.

This argument comes up twice a year, then slowly goes away. You can't kill the operator/anesthesia team model because some hack in Hawaii didn't have the skills necessary to be giving any sort of sedation, oral or IV. By this logic, all anesthesiologists shouldn't use propofol because an MD killed MJ with it.

And it is a horrible story that I hope we never have to read about again. I just don't think that 2 different providers will make anesthesia-related deaths extinct, i.e. Maryland.
 
Disclaimer!!! I did not read all previous posts so if I am being redundant I apologize.
Anyone who says a blanket statement that GP's doing IV or oral sedation is unsafe and should never be done, needs to rethink their stance.
Any healthcare professional who has adequate training and uses appropriate criteria for case selection can do anything they want. One should not be so brazen to make a statement that all OMFS are more knowledgeable about airway management then any other dental specialist!!! At the end of the day it's all about the training and experiences you have. I have spoken with OMFS residents who are ready to graduate who have never had to treat a laryngospasm (since they are extremely skilled at their anesthesia technique, and can suction an airway so efficiently) or give reversal agents; and a GPR resident who during his two weeks of anesthesia rotation had hands on experience with both issues, then completed a two week mini residency in parentarel sedation. So who is better trained to deal with a laryngospasm or an overdose? The person with years of training who has never had to treat the complication or the person who has actually done it twice!
It's like my ACLS instructor said, "if you need ACLS you want me to be the one working on you, if you need a tooth out, stay far away from me"!!! Having a higher degree and years of training does not necessarily translate to better clinical skills or know how.
Dentistry is barbaric!! What other field of health care would patients be expected to go through painful lengthy procedures with just local anesthetic and a suck it up attitude. The ability for general dentists to provide mild to moderate sedation is fantastic! It allows for increased patient comfort, and access for patients with severe phobia.
Basically my point is... sedation performed by GP's is, and will continue to be extremely safe if the provider uses appropriate case selection and follows their training.
The pissing contest between dental specialties is ages old and only hinders professional camaraderie. I hate the constant bitching and moaning of OMFS complaining about having to clean up after "*****" GP's doing procedures that they have no idea how to deal with the complications. Guess what!!! Oral surgeons screw up too, and then plastic surgeons and ENT surgeons complain about them cleaning up for OMS. Just be respectful to all, and if someone screws up... help your fellow heathcare provider out.
Thats All!!!!
 
So here is the State of Hawaii's solution to the problem of unregulated oral sedation. If you provide sedation by any modality (oral or IV) in the state of Hawaii you will need a permit from the Board. To get that permit you would have to either have taken and IV conscious sedation course (60 hrs and 20 live patients) or be educationally qualified (OMS, Dental Anesthesiology)

Star-Advertiser, January 25, 2014: "Most states do address all types of sedation, all the way through general anesthesia, and the required training and documentation for each of those," said Dr. Joel Berg, immediate past president of the American Academy of Pediatric Dentistry.

Hawaii Administrative Rules on Dentistry have long required dentists to get advanced training and written authorization from the state Board of Dental Examiners to administer general anesthesia and intravenous-conscious sedation. They also require dentists to have proper facilities and staff to handle problems and emergencies in such cases.

But the regulations had been silent on oral sedatives, which can induce mild or moderate sedation, depressing the central nervous system.

On Jan. 16, however, Gov. Neil Abercrombie signed new rules requiring dentists to complete comprehensive postgraduate training that meets American Dental Association guidelines and obtain permits before administering "moderate conscious sedation," whatever the mode of drug delivery. The rules were approved by the Board of Dental Examiners in July and have been undergoing administrative review since then.

From Hawaii State Board regulations:
Moderate (conscious) sedation: Applicant has completed a comprehensive training program at the postgraduate level that meets the moderate (conscious) sedation program objectives and content as outlined in the current ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students. The training program shall be a minimum of sixty hours of instruction, include supervised management of at least twenty moderate (conscious) sedation patients with clinical experience in managing the compromised airway and establishment of intravenous access, and provide current documented proficiency in Basic and Advanced Cardiac Life Support
 
You must log in or register to reply here.

Similar threads

P
**Pediatric Fellowship Opportunity**
Replies
0
Views
610
pedodental4456
P
S
Pediatric
Replies
0
Views
651
shahsara
S
B
  • Poll Poll
Pediatric Dentistry Residency Poll
Replies
1
Views
2K
adam's_song
adam's_song
P
OFFICIAL PASS 202[emoji239] PEDIATRIC RESIDENCY INFORMATION
Replies
4
Views
845
palmtree111
P
G
Buying pediatric dental boards study materials
Replies
0
Views
568
Greentea23
G
Top