IV sedation

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Hi all! I am interested in learning IV sedation as a general dentist, but only if I can make it safe and predictable. Obviously there are a variety of courses that lead to certification, but I am more so concerned about managing complications. What are the thoughts of becoming a paramedic prior to learning IV sedation? I would assume that learning to manage the airway and learning intubation as a paramedic may be beneficial for performing IV sedation in a case of emergency. Any thoughts on this? I do realize you don't become a paramedic overnight.

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Of course there is no question that DA and OMFS is ideal for administration of IV sedation. I am a GP 3 years out of school having done a GPR, but no official sedation training. No doubt a residency would be the ideal course of action, but I am trying to see if this could be done safely without the rigors of an additional residency. Also, I would like to incorporate IV sedation into my practice as a general dentist, and not jump ship completely into a surgical speciality or anesthesia program at this time. Being a paramedic would seem like a good "insurance policy" in the case something does not go as planned in the office. I am open to any suggestions.

 

[vellnueve]

Of course there is no question that DA and OMFS is ideal for administration of IV sedation. I am a GP 3 years out of school having done a GPR, but no official sedation training. No doubt a residency would be the ideal course of action, but I am trying to see if this could be done safely without the rigors of an additional residency. Also, I would like to incorporate IV sedation into my practice as a general dentist, and not jump ship completely into a surgical speciality or anesthesia program at this time. Being a paramedic would seem like a good "insurance policy" in the case something does not go as planned in the office. I am open to any suggestions.

Paramedics/EMTs get those skills by repetition, not just by taking the course and getting certified. It would be a waste of time.

 

[OhioDMD]

Hi all! I am interested in learning IV sedation as a general dentist, but only if I can make it safe and predictable.

Not to be a curmudgeon but you might want to add practical and profitable. Don't get me wrong, IV sedation is a great service for the patient with an excellent safety record with proper patient selection. However unless things have recently changed it is usually not a covered service by dental insurance plans (* general anesthesia is for certain procedures and circumstances) and depending on your patient base they may not accept IV sedation as a treatment modality. Which leaves you going into competition with the oral surgeons, periodontists and endodontists for patients whose procedures by length or difficulty would be better rendered on a sedated patient or you end up with a lot of difficult management patients (extreme dental anxiety).

Now for the profitable part. You will pay a higher malpractice rate to perform IV sedation also for some of the procedures you may offer (implant placement & impacted 3rds). You will be required (state dental board) to have more advanced cardiac life support equipment in your office (generally not a bad idea) and know how to use them (also not a bad idea...think defibrillator units you see hanging on the walls). Not to mention the myriad of drugs necessary to treat possible emergencies and their replacement when they have expired. Unfortunately profitable dentistry is a numbers game. IV Sedation will slow you down (preparation, induction & recovery) unless you have a well trained staff and room for recovery in your setting.

IMHO most general dentists would be better served with Nitrous Oxide and a good knowledge of oral anxiolytic drugs.

 

[Saddleshoes]

Not to be a curmudgeon but you might want to add practical and profitable. Don't get me wrong, IV sedation is a great service for the patient with an excellent safety record with proper patient selection. However unless things have recently changed it is usually not a covered service by dental insurance plans (* general anesthesia is for certain procedures and circumstances) and depending on your patient base they may not accept IV sedation as a treatment modality. Which leaves you going into competition with the oral surgeons, periodontists and endodontists for patients whose procedures by length or difficulty would be better rendered on a sedated patient or you end up with a lot of difficult management patients (extreme dental anxiety).

Now for the profitable part. You will pay a higher malpractice rate to perform IV sedation also for some of the procedures you may offer (implant placement & impacted 3rds). You will be required (state dental board) to have more advanced cardiac life support equipment in your office (generally not a bad idea) and know how to use them (also not a bad idea...think defibrillator units you see hanging on the walls). Not to mention the myriad of drugs necessary to treat possible emergencies and their replacement when they have expired. Unfortunately profitable dentistry is a numbers game. IV Sedation will slow you down (preparation, induction & recovery) unless you have a well trained staff and room for recovery in your setting.

IMHO most general dentists would be better served with Nitrous Oxide and a good knowledge of oral anxiolytic drugs.

+1

 

[PreDentTechySon]

Of course there is no question that DA and OMFS is ideal for administration of IV sedation. I am a GP 3 years out of school having done a GPR, but no official sedation training. No doubt a residency would be the ideal course of action, but I am trying to see if this could be done safely without the rigors of an additional residency. Also, I would like to incorporate IV sedation into my practice as a general dentist, and not jump ship completely into a surgical speciality or anesthesia program at this time. Being a paramedic would seem like a good "insurance policy" in the case something does not go as planned in the office. I am open to any suggestions.

In my opinion, there really is no way to do this safely without the rigors of an additional residency. Even with proper patient selection issues and complications come up and it takes training and extensive knowledge of how to handle them.

One example I have (that actually happened twice) happened when I used to work with an OMFS. Normal, ASA I healthy adult male presented for IV sedation for implant placement. During sedation, patient had breathing complications and had an obstructed airway. This Surgeon handled everything amazing. Addressed the airway complication and brought the patient into a safe level of sedation. He finished the procedure and brought the patient out of sedation. Turns out the patient had sleep apnea and didn’t think it was relevant to add in his Medical HX.

I personally don’t see how someone can learn how to manage those kinds of complications outside of a residency.

 

[Anonymomfs]

There are certain techniques beyond intubation that need to be practiced on real people (bag masking, for example) before you truly can master them/know what their limits are with respect to body habitus/medical problems. There are far more profitable and safer dental disciplines you can adopt to help your patients.

If you do have a procedure that needs an anesthesiologist, dental anesthesiologists and even general anesthesiologists can come to your office (which of course would still need to be outfitted for such procedures) and provide that service for you, taking a load of liability off of your shoulders.

If something goes wrong with an implant, you're not talking life or death in a matter of minutes. Sedating your patients with limited training is a strange hill to die on. If you can find some course (or EMT training) that makes you 100% completely proficient in airway management, by all means sedate away. But I can't imagine that weekend courses can provide that.

 

[nealofgrafton]

To the OP- you'll be better served learning to write for anxiolysis. I went and got an oral concious sedation training and permit. if you look at it from a purely cash view for oral concious sedation (which is garbage in my opinion) I lost a ton on that. If you take into account how much more comfortable it make me writing 'snacks' of anxiolysis meds- I've made a boat load

GP's with IV sedation permits (in most states) are not allowed to use certain medications that are used on most OMFS/ DA/ ANES cases (such as propofol). It's tough to impede patients breathing with just midazolam