Oral/Max facs administering anaesthesia?

[Licoricestick]

Came across this by accident

The ability to provide patients with safe, effective outpatient anesthesia has distinguished the specialty of oral and maxillofacial surgery since its earliest days. As the surgical specialists of the dental profession, Oral and Maxillofacial Surgeons are trained in all aspects of anesthesia administration. Following dental school, Oral and Maxillofacial Surgeons complete at least four years of training in a hospital-based surgical residency program alongside medical residents in general surgery, anesthesia and other specialties. During this time, OMS residents must complete a rotation on the medical anesthesiology service, during which they become competent in evaluating patients for anesthesia, delivering the anesthetic and monitoring post-anesthetic patients.


As a result of this extensive training, Oral and Maxillofacial Surgeons are well-prepared to identify, diagnose and assess the source of pain and anxiety within the scope of their discipline, and to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Further, they are experienced in airway management, endotracheal intubation, establishing and maintaining intravenous lines, and managing complications and emergencies that may arise during the administration of anesthesia.

http://www.aaoms.org/anesthesia_info.php

Does this really happen? Are SURGEONS actually administering anaesthesia, BY THEMSELVES, in an office environment? Or is this just their organisation trying to make them sound better?

Are the max facs surgeons in the US MD/DO trained or just dental school alone?

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[nutmegs]

Came across this by accident


http://www.aaoms.org/anesthesia_info.php

Does this really happen? Are SURGEONS actually administering anaesthesia, BY THEMSELVES, in an office environment? Or is this just their organisation trying to make them sound better?

Are the max facs surgeons in the US MD/DO trained or just dental school alone?

Our OMFS residents rotate through our department for 3 months and spend 2 months of that doing general cases solo (just like a beginning anesthesia resident). Obviously they are not in heart, thoracic, neuro cases but they do gyn, ENT, OMFS, uro/cysto, etc. The way it was explained to me the other day was that there are 2 pathways
1. finish dental school and then complete OMFS residency (4 years) for DMD with OMFS qualifications
2. finish dental school and then complete MS3/MS4 after taking step 1, then 1 year general surgery residency, then 3 years OMFS residency (6 years) for DMD/MD

but, there isn't really a difference in who can do what afterwards.

I hope I got that right.

 

[Handinhand]

Just a pre-med but I saw this as the front post in here and thought I would respond. When I got my wisdom teeth out the oral surgeon administered the gen. anesthesia after the nurse gave me the nitrous.

 

[desflurane]

Yes the training paths you mention are exactly correct and yes they do routinely administer everything from light sedation to GETA. To their credit they do get way more anesthesia training than the average MD surgeon of any specialty. Most guys won't put an ET tube in for wisdom teeth but do go pretty heavy with the propofol. Many even have full anesthesia machines with vaporizers to mask the down the kiddies.

My experience is that many are moving away from the liability and shifting it to us, for better or for worse. Some gas passers have been making quite a good living providing this as an office based service. Search "sedation dentistry" and you'll find a ton of people offering this and patients willing to pay.

We aren't the only people giving anesthesia, just the most qualified. Inevitably it takes one bad experience and they'll call us.

 

[pgg]

Our OMFS residents rotate through our department for 3 months and spend 2 months of that doing general cases solo (just like a beginning anesthesia resident).

Same at my program.

Most were very good. Far more motivated and capable than many of the med students, interns, and off-service residents who rotated with us for a month to learn how to intubate while studiously avoiding learning anything else about anesthesia.

They recently got new Drager Apollo machines for their clinic. As good as they were, for 3-month rotators, that made me a little uncomfortable. Make that a lot uncomfortable.

 

[BLADEMDA]

Yes the training paths you mention are exactly correct and yes they do routinely administer everything from light sedation to GETA. To their credit they do get way more anesthesia training than the average MD surgeon of any specialty. Most guys won't put an ET tube in for wisdom teeth but do go pretty heavy with the propofol. Many even have full anesthesia machines with vaporizers to mask the down the kiddies.

My experience is that many are moving away from the liability and shifting it to us, for better or for worse. Some gas passers have been making quite a good living providing this as an office based service. Search "sedation dentistry" and you'll find a ton of people offering this and patients willing to pay.

We aren't the only people giving anesthesia, just the most qualified. Inevitably it takes one bad experience and they'll call us.

Agree. Most give propofol, heavy propofol, but GA and they get gun-shy.
Some will hire and "supervise" a CRNA for routine cases; others know what can go wrong and want a Board Certified MD.

Cosmetic Surgery and Poor Outcome just aren't a good mix.

 

[2win]

Came across this by accident


http://www.aaoms.org/anesthesia_info.php

Does this really happen? Are SURGEONS actually administering anaesthesia, BY THEMSELVES, in an office environment? Or is this just their organisation trying to make them sound better?

Are the max facs surgeons in the US MD/DO trained or just dental school alone?

And anesthesiologists can safely perform oral surgery!
That's great!

 

[Licoricestick]

Let me check I have this right...there are people out there (some of whom are not medical doctors), who have a grand total of 3 months of anaesthetic training (ie they haven't seen a fraction of the things that can go wrong let along managed those problems themselves), who are administering anaesthesia (including GA) in an office base environment (so no backup available) as well as performing the surgical procedure - which involves a bloody airway.... And you guys are worried about the CRNAs having independence??????

 

[thegasman]

Just a pre-med but I saw this as the front post in here and thought I would respond. When I got my wisdom teeth out the oral surgeon administered the gen. anesthesia after the nurse gave me the nitrous.

you were probably given heavy iv sedation with propofol and local.

 

[Handinhand]

you were probably given heavy iv sedation with propofol and local.

You got that right, I was out cold. Woke up in the recovery room tearing the gauze out of my mouth and the assistant telling the oral surgeon I'm being a pain in the ass.

Oh, and what ever he put into my IV (he did start one) was milky white, if that helps at all.

 

[scudrunner]

You got that right, I was out cold. Woke up in the recovery room tearing the gauze out of my mouth and the assistant telling the oral surgeon I'm being a pain in the ass.

Oh, and what ever he put into my IV (he did start one) was milky white, if that helps at all.

I had wisdom teeth removed a year and a half ago in an office, and the doc was a MD/DMD. His IV was a 23 ga. butterfly and whatever he gave me was a clear liquid time machine. I was out cold, quick, and woke up quick too, but still groggy. I thought it was a neat experience, since I've never had general anesthesia before.

 

[Handinhand]

I had wisdom teeth removed a year and a half ago in an office, and the doc was a MD/DMD. His IV was a 23 ga. butterfly and whatever he gave me was a clear liquid time machine. I was out cold, quick, and woke up quick too, but still groggy. I thought it was a neat experience, since I've never had general anesthesia before.

I thought the nitrous before hand was the best. I understand the whole laughing gas thing now, because I couldn't stop laughing and there wasn't even anybody in the room with me! Bad experience though, tearing that gauze out wasn't the best idea, which I found out a few days later when I woke up with dry sockets... 3 to be exact.

 

[thegasman]

You got that right, I was out cold. Woke up in the recovery room tearing the gauze out of my mouth and the assistant telling the oral surgeon I'm being a pain in the ass.

Oh, and what ever he put into my IV (he did start one) was milky white, if that helps at all.

milky white is propofol.

 

[thegasman]

I had wisdom teeth removed a year and a half ago in an office, and the doc was a MD/DMD. His IV was a 23 ga. butterfly and whatever he gave me was a clear liquid time machine. I was out cold, quick, and woke up quick too, but still groggy. I thought it was a neat experience, since I've never had general anesthesia before.

clear liquid was probably brevital (methohexital) relatively short acting barbituate, does cause a little hangover/groggy feeling. Most OMFS have switched to using propofol for their heavy sedation.

 

[cfdavid]

Same at my program.

Most were very good. Far more motivated and capable than many of the med students, interns, and off-service residents who rotated with us for a month to learn how to intubate while studiously avoiding learning anything else about anesthesia.

They recently got new Drager Apollo machines for their clinic. As good as they were, for 3-month rotators, that made me a little uncomfortable. Make that a lot uncomfortable.

That's got to be frusterating. During MS3, I did my rotation in January, so most of the MS4's really into anes already did their rotations. So, I was with quite a few students going into other specialties that just wanted to do the procedures without giving a rats a.s about anesthesiOLOGY. It even frusterated ME. LOL

 

[huktonfonix]

milky white is propofol.

or someone mixed the wrong meds

 

[DREDAY]

Morbidity and mortality with outpatient anesthesia: The experience of a residency training program
Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 7, Pages 684-687
M.Hunter, A.Molinaro


Previous studies regarding anesthetic-related morbidity and mortality rates in the oral surgery office have usually taken the form of a survey. This retrospective investigation of outpatient anesthetic morbidity and mortality was undertaken to compare the safety record of an oral and maxillofacial surgery training program with that of private practitioners.

Records from all outpatient general anesthesia cases performed in the Department of Oral and Maxillofacial Surgery at the Boston University Goldman School of Graduate Dentistry between August 13, 1990, and September 30, 1994, were reviewed for the incidence of nineteen separate categories of morbidity.

There were 1,126 general anesthetics performed. There were 26 recorded incidents of morbidity (2.3%), none of which resulted in any postoperative sequelae. There were no deaths. The most common complication encountered was laryngospasm, with nine recorded incidents (0.8%). The second most common complication was cardiac dysrhythmia with eight recorded incidents (0.8%).

The low incidence of anesthetic-related morbidity seen in this study can most likely be attributed to proper patient selection. A carefully reviewed medical history and physical examination are the two most useful methods to prevent anesthetic emergencies. Another factor considered when selecting the proper anesthetic method includes the length and difficulty of the surgical procedure, with outpatient general anesthesia being reserved for those procedures that are predicted to be relatively short (30 to 45 minutes), and with little potential for airway difficulties.

 

[DREDAY]

Adverse events with outpatient anesthesia in Massachusetts

Edward M D’Eramo, DMDCorresponding Author Information∗, Steven J Bookless, DDS†, Joanne B Howard‡

Abstract

Purpose: This retrospective study documented the frequency of various complications associated with outpatient anesthesia.

Patients and Methods: A questionnaire was mailed to the 157 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons (MSOMS) and all members responded. Morbidity data were obtained for the calendar year 1999. Mortality data included 1999 and the preceding 4 years. This continues our long-term survey of ambulatory oral surgical office deaths in Massachusetts since 1984. The data include anesthesia-related complications and all office deaths for the patients treated by these oral and maxillofacial surgeons.

Results: The most common complication in our survey continues to be syncope, which occurred in 1 in 160 patients receiving local anesthesia. The incidences of other specific anesthetic problems are given. Two treatment-related deaths occurred among approximately 1,706,100 patients treated during the 5-year period of 1995 through 1999, for a mortality rate of 1/853,050.

Conclusions: The results of this retrospective practitioner survey documented the specific incidence of untoward anesthetic events with outpatient anesthesia and found a mortality rate consistent with the 6 similar mortality studies since 1980. These 7 retrospective reviews found 34/28,399,193 outpatient deaths for an overall dental anesthesia mortality rate of 1/835,000.

 

[DREDAY]

The patients that will undergo in office sedation are ASA 1 and ASA 2, rarely ASA 3.

 

[ProRealDoc]

That's got to be frusterating. During MS3, I did my rotation in January, so most of the MS4's really into anes already did their rotations. So, I was with quite a few students going into other specialties that just wanted to do the procedures without giving a rats a.s about anesthesiOLOGY. It even frusterated ME. LOL

Had a few of those. When assigned to me, they only got to watch.

 

[armorshell]

Office-Based Ambulatory Anesthesia: Outcomes of Clinical Practice of Oral and
Maxillofacial Surgeons
David H. Perrott, DDS, MD, MBA,* Judy P. Yuen, MA,†
Randi V. Andresen, BS,‡ and Thomas B. Dodson, DMD, MPH

34,191 patients receiving GA, 2 required hospitalization, 0 deaths. You are 300% more likely to be struck by lightning then to be put in the hospital by an oral surgeon.

 

[shabu2]

Let me check I have this right...there are people out there (some of whom are not medical doctors), who have a grand total of 3 months of anaesthetic training (ie they haven't seen a fraction of the things that can go wrong let along managed those problems themselves), who are administering anaesthesia (including GA) in an office base environment (so no backup available) as well as performing the surgical procedure - which involves a bloody airway.... And you guys are worried about the CRNAs having independence??????

We are required to have 4months of GA training, and an extra pediatric GA month, plus get training to do surgical airways (trach and crico's). We are well aware of the complications and dangers of GA and airway management and do not take this lightly. Our training provides a patient with a safe option to their treatment plan. Usually, moderate to deep sedation is what we administer. GA cases go to the OR and in the hands of the Anesthesiologists. I find that most MD's are not aware of our scope, capabilities and breadth of training, and are quick to dismiss it as "dental". I would pit any well trained OMFS against any other medical surgical subspecialty, and all who have encountered us have nothing but kudos to report. Clearly there are some MD's who are not qualified to administer GA either (RIP Michael). 😉

 

[pgg]

We are required to have 4months of GA training, and an extra pediatric GA month, plus get training to do surgical airways (trach and crico's). We are well aware of the complications and dangers of GA and airway management and do not take this lightly. Our training provides a patient with a safe option to their treatment plan. Usually, moderate to deep sedation is what we administer. GA cases go to the OR and in the hands of the Anesthesiologists. I find that most MD's are not aware of our scope, capabilities and breadth of training, and are quick to dismiss it as "dental". I would pit any well trained OMFS against any other medical surgical subspecialty, and all who have encountered us have nothing but kudos to report. Clearly there are some MD's who are not qualified to administer GA either (RIP Michael). 😉

As I wrote in my previous posts, I was uniformly impressed with all of the OMFS residents who came through our department when I was a resident. Moderate to deep sedation is clearly within their scope of practice. But training in general anesthesia isn't (mustn't) be interpreted as preparation for a career delivering GETAs to patients in their offices. It's good to hear that your GA cases go to the OR but I've also heard OMFS guys talking about such things as using the anesthesia machines in their offices to "mask down kids" ... they're a little too comfortable with anesthesia for my comfort.

People who aren't anesthesiologists - or CRNAs/AAs under appropriate circumstances - shouldn't be blowing sevoflurane at kids or otherwise delivering general anesthetics.

And yes, there are a lot of MDs who aren't qualified to adminster GA: all of them who aren't anesthesiologists. The fact that some quack bumped off a rock star with propofol isn't at all relevant to this issue.

 

[shabu2]

It's good to hear that your GA cases go to the OR but I've also heard OMFS guys talking about such things as using the anesthesia machines in their offices to "mask down kids" ... they're a little too comfortable with anesthesia for my comfort.

People who aren't anesthesiologists - or CRNAs/AAs under appropriate circumstances - shouldn't be blowing sevoflurane at kids or otherwise delivering general anesthetics.

This is a minority and not the norm, but still within our scope. We are usually seeing ASA I kids for a quick 1min primary tooth extraction, and masking down adds another trick up the sleeve. I would rather have a machine in my office than not just to have another option even though we may not use them daily. Finally, anything is nerve-racking on kids period.

And yes, there are a lot of MDs who aren't qualified to adminster GA: all of them who aren't anesthesiologists. The fact that some quack bumped off a rock star with propofol isn't at all relevant to this issue.

This was a joke, not to be taken so seriously, but IV sedation and anesthesia are powerful tools that need to respected. Peace.

 

[Bifid Uvula]

We are by no means fully trained as Anesthesiologists, but our training is the most extensive and comprehensive of any medical specialty after Anesthesiologists and CRNAs. We are perhaps the only surgical specialty that actually has a clue what goes on behind the surgical drape/curtain...

OMFS residents are required to spend a minimum of 4 months as rotating residents in the department of Anesthesiology. They spend this time at the PGY 1 or PGY 2 level. But that is not the end of the anesthesia training that OMFS residents get... They spend about 3 more years providing IV Sedation and General Anesthesia on an almost daily basis in the OMFS clinic. In addition, the OMFS residents are BLS/CPR, ACLS and ATLS trained/certified..and also usually re-certify prior to completing the residency. (Our other off service rotations only reinforce our medical training... Internal Medicine 2 months, ER 1 month, Trauma Surgery 2 months, General Surgery 2 months, ENT 1 month, ICU 1 month).

At my program we spend a total of 5 months on the Anesthesia Service. We also spend a month strictly providing pediatric anesthesia. Then for the remainder of our residency while we are on the OMFS service (3 years) we provide IV and GA anesthesia 2-4 times per week on 4-6 patients per day. We receive formal anesthesia lectures 2 times per month. In fact one of our attendings holds appointments to both the OMFS and Anesthesia Departments. At our institution we also have the option to do a 1 year Anesthesia fellowship in the department of anesthesiology after completion of our residency.

In our program, we get Anesthesia trained for 4 months in the first year or residency in order to maximize our anesthesia experience over the remainder of our residency. By the 2nd or 3rd week we are expected to run our own rooms... In our 3rd year we return to the Anesthesia service for additional pediatric training (Although I would say that probably 90% of the private OMFS won't sedate peds in their office).

I can tell you that our program prepares us to provide safe and effective GA and IV Sedation for ASA I/II and some III's... We can manage the airway pretty effectively, and are prepared for cricothyroidotomy or tracheostomy (since we are the primary trach service in the hospital).

Our intubation training continues outside of the OR and is reinforced in our clinic where we continue to provide Oral and Nasal intubations, including blind awake nasal intubation, fiberoptic intubation, retrograde intubation. Oh yah, we all get comfortable with submental intubation as well... sparing people uncessary tracheostomies...

Also consider the nature of the majority of the surgical procedures we provide in our clinics/private offices... fast procedures where we are intimately involved with and close to airway... therefore better able to monitor the airway.

Finally, we are tested in Anesthesia, Medicine, and Medical Emergencies as part of our Written and Oral Boards...

wow, that was a longer response than I anticipated... hope this helps.