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Yeah you won’t find a single anesthesiologist who would agree that a plastic surgeon is qualified to supervise a CRNA.
Sad story, another anesthesia death. Seems like only a matter of time before they impose changes on our profession.
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Yeah you won’t find a single anesthesiologist who would agree that a plastic surgeon is qualified to supervise a CRNA.
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thats very true. lighter levels of sedation should be the goal of the oral surgeon for safety reasons.
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Hi Eli,
Don't let the vituperative get you down. Never apologize to jerks. They have no good will.
Dr. IMgasm is clearly an MDA who hates anesthesia provided by the dental profession. She/he will never treat you with respect.
Having said that, don't insult her/him/them either. That will not advance the truth.
There is plenty wrong in their box that needs attending to, before they come here and tell me how to manage an unintubated airway.
No one does this better than us.
Don't tell her/him/them this, but anesthesia was invented by the dental profession. It was first practiced by dentists for dental procedures. Then, it was practiced by only nurses for over 50 years before physicians got involved.
You may not know this, but there is now a huge turf battle between MDA's and CRNA's. And it all boils down to money.
Don't get me wrong, the best thing to ever happen to anesthesia was for it to become a specialty in medicine.
But don't let mean jerks tell you what you can do. They claim to care about the patient. We all do that.
Notice that no one has given any facts that support the notion that OMS's should not provide anesthesia without a separate anesthetist/anesthesiologists.
It is all emotion and money.
Don't let the vituperative get you down. Never apologize to jerks. They have no good will.
Dr. IMgasm is clearly an MDA who hates anesthesia provided by the dental profession. She/he will never treat you with respect.
Having said that, don't insult her/him/them either. That will not advance the truth.
There is plenty wrong in their box that needs attending to, before they come here and tell me how to manage an unintubated airway.
No one does this better than us.
Don't tell her/him/them this, but anesthesia was invented by the dental profession. It was first practiced by dentists for dental procedures. Then, it was practiced by only nurses for over 50 years before physicians got involved.
You may not know this, but there is now a huge turf battle between MDA's and CRNA's. And it all boils down to money.
Don't get me wrong, the best thing to ever happen to anesthesia was for it to become a specialty in medicine.
But don't let mean jerks tell you what you can do. They claim to care about the patient. We all do that.
Notice that no one has given any facts that support the notion that OMS's should not provide anesthesia without a separate anesthetist/anesthesiologists.
It is all emotion and money.
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I don’t think our model is perfect. And if there are deaths then something should be done. there should be stricter requirements for dentists doing any anesthesia. There should be more transparency with the public. I can understand what the anesthesiologists are saying.
I never go to the anesthesiology boards. But I found my way there via this thread. And saw some of the most rediculous things said. It’s clear that some of the people in that forum have absolutely no idea about dentistry, what it is, what we do, how things work. Which is kinda sad. But what can u do?
The other troubling part - oms has worked relentlessly to seperate ourselves from general dentists regarding sedation. And the reality is our training far exceeds a general dentist when it comes to sedation in the office. But it seems we will always be lumped in with general dentists, pediatric dentists ect when the public or other healthcare providers look at these situations
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I don't think OMFS will "always be lumped with dentists," but when things go wrong, you can bet salty anesthesiologists will call board-certified surgeons "a bunch of dentists" on online forums. It's the same way OMFS will look down on anesthesiologists because their jobs are "Easy." Don't take it personally or find it troubling because the medical community will always shoot shots at other specialties.
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This goes back to day 1 of dental school, Embryology and Gross Anatomy. At my school we all sat in the same lecture hall, maybe 160 med students and 90 dental students. The med students literally had no clue we were there IN THE SAME ROOM. Stick around here long enough and every few years you will see a med student come over here and ask how they can apply to OMFS residency and then be shocked when told they have to go to dental school first. I'm glad to be long gone from having to deal with physicians and can absolutely appreciate that OMFS can sedate the 12 year olds I refer with those brutally impacted canines that would be stupid to touch with local. Or the 12 year olds that cry in the ortho chair when you tell them the treatment plan includes having to get 4 teeth extracted if they don't want to live with a snaggle mouth. They get a referral straight to OMS, skip the GP trying to do that with local.
The only thing this thread has me wondering is ACLS required if you're offering sedation? ACLS was no joke when I was forced to take it for my GPR. I renewed my BLS the other day and that was way to simplistic to handle the kinds of things being discussed here. I assume that if I'm referring a patient to any of my local OMS that offer sedation, they keep their ACLS up to date.
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the anesthesiologists are pretty good at what we do too. They typically take out teeth with their mac or Miller blades on a routine basis !!
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Yes sir, NP or PA.
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OMG, " a truckload of cans of worms". I haven't laughed like that in a while so thanks for that.
D
deleted1047421
I couldn't agree with you more.
The midlevels have completely bastardized the field of anesthesia (with CRNAs and AAs). Now MD anesthesiologists have to leverage their license to run as many rooms as possible, while leaving their patients in the hands of a CRNA or even worse, an AA. All so they can bill patients and their insurance for multiple anesthetic deliveries simultaneously. This maximizes production for the anesthesiologist and hospital.
This problem has also made its way throughout medicine, not just anesthesia. For example look at MD surgeons.
Home
With midlevels, medicine has changed. MD surgeons can operate multiple surgeries simultaneously. Cardiothoracic surgeons, neurosurgeons, orthopaedic surgeons etc, can run multiple operating rooms at once, getting surgical assistants/mid levels to perform a significant portion of the procedure themselves.
You read that correctly - if you need surgery in the US, the surgeon that you thought was performing the procedure may not have done all of it - he/she was running multiple operating rooms and a surgical assistant (mid level - someone with 2 years or less of training post bachelors degree) may have actually did the majority of the procedure themselves, unsupervised.
OMFS and dentistry has kept themselves safe from midlevels up until now. Adding CRNAs will not make our anesthesia and surgical delivery in OMFS any safer.
We have the data and evidence that proves our model is safe and effective, and our anesthesia complication rate is incredibly small.
It has been this way for the past >90 years. We didn't start doing this yesterday.
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Would a nurse look at a wizzy and then inform the surgeon? How would this work?
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I couldn't agree with you more.
The midlevels have completely bastardized the field of anesthesia (with CRNAs and AAs). Now MD anesthesiologists have to leverage their license to run as many rooms as possible, while leaving their patients in the hands of a CRNA or even worse, an AA. All so they can bill patients and their insurance for multiple anesthetic deliveries simultaneously. This maximizes production for the anesthesiologist and hospital.
This problem has also made its way throughout medicine, not just anesthesia. For example look at MD surgeons.
Home
www.surgicalassistant.org
With midlevels, medicine has changed. MD surgeons are pressured to operate multiple surgeries simultaneously, running multiple operating rooms at the same time. Cardiothoracic surgeons, neurosurgeons, orthopaedic surgeons etc, all run multiple operating rooms at once, getting surgical assistants/mid levels to essentially perform the entire procedure themselves.
You read that correctly - if you need surgery in the US, the surgeon that you thought was performing the procedure didn't actually do it - he/she was running multiple operating rooms and a surgical assistant (mid level - someone with 2 years or less of training post bachelors degree) may have actually did the majority or entire procedure themselves.
OMFS and dentistry has kept themselves safe from midlevels up until now. Adding CRNAs will not make our anesthesia and surgical delivery in OMFS any safer.
We have the data and evidence that proves our model is safe and effective, and our anesthesia complication rate is incredibly small.
It has been this way for the past >90 years. We didn't start doing this yesterday.
Much of this is so wrong it’s crazy. In fact, this reads like you’re a mid level spouting propaganda. Have you ever worked in an OR?
Are there surgeons running multiple rooms? Yes. Is it for much more than skin closure and the saving of OR turn over time? No. If you’re a dentist this is akin to your hygienists doing the pre-cleaning before and whatever else after you do the exam and polish then scurry on to the next patient in the next room that hygienist B just prepped for you.
In fact a couple large academic institutions have recently gotten absolutely nailed for flying too close to the sun when it comes to one surgeon running multiple rooms and not being present for all “critical portions” of each case. It’s huge CMS billing fraud. It is not ok.
There are mid levels assisting surgeons, even doing small complimentary portions of certain procedures (an example is endoscopic vein harvesting for coronary artery bypass procedures) but literally no mid level performs surgery without an MD/DO surgeon.
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Colorado plastic surgeon charged after death of breast implant patient, 18
A Colorado plastic surgeon who lost an 18-year-old patient during a breast augmentation procedure is behind bars outside Denver on charges of aggravated assault and criminally negligent homicide.
for whatever it's worth, it could happen to all of us when playing with fire
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This whole thread has reminded me why I chose dentistry (ortho) over medicine. The potential for a single lost life was more than I could deal with.
My neighbor is a MD anesthesiologist. He told me that statistically .... after doing many, many procedures that someone was going to die. Eventually. Regardless if everything was handled properly. Part of the profession he told me.
My neighbor is a MD anesthesiologist. He told me that statistically .... after doing many, many procedures that someone was going to die. Eventually. Regardless if everything was handled properly. Part of the profession he told me.
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There is a great Podcast called "everyday oral surgery" and there is an episode where the guest, a guy out of Denver, talks about how his practice recently integrated an NP into the practice to do post ops and consults. Essentially, you would have the NP/PA see the patient, review all the information, evaluate the patient and then present them to you. Then you come in the room, quickly double checks the exam of the patient and then ask the patient if there are questions. Could save a lot of time on data gathering and is similar too many medical models that currently exist. The podcast person stated that it has added 500K/surgeon to the bottom line for what thats worth. Thats not nothin. I can certainly anticipate problems with AAOMS not liking that someone else is evaluating the patient for a sedation. This model already exists in medicine so there is precedent. I do not employ this technique in my PP but if I was a PP guy with multiple offices and partners I think this is something to think about. The future perhaps?
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Sorry to revive this thread, but I keep seeing news articles about the dental anesthesia rules in NC that say that they are proposing that an MD anesthesiologist or CRNA be present for deep sedation dental cases. However, when I read the proposed rules (attached here), it doesn't say that.
The proposed rules state:
The dedicated sedation auxiliary shall be:
Is there something I am missing?
The proposed rules state:
"During a sedation procedure involving the administration of general anesthesia, moderate conscious sedation, or moderate pediatric conscious sedation, the permit holder performing the surgical or other dental treatment shall utilize either a dedicated sedation provider or a dedicated sedation auxiliary as set out in this Rule. The dedicated sedation provider or dedicated sedation auxiliary shall not perform the surgical or dental treatment or any other dental assisting tasks during the sedation procedure.
For purposes of this Rule, a "dedicated sedation auxiliary" shall mean an auxiliary with an unexpired ACLS 27 certification who is dedicated to patient monitoring and recording anesthesia or sedation data throughout the sedation 28 procedure.
The dedicated sedation auxiliary shall be:
(1) an RN licensed and practicing in accordance with the rules of the North Carolina Board of Nursing; or
(2) a dental assistant with proof of an unexpired dental anesthesia assistant certification from the Dental Anesthesia Assistant National Certification Examination program offered by the American Association of Oral and Maxillofacial Surgeons, or from another Board-approved dental anesthesia assistant certification program. A list of approved programs is available on the Board's website at www.ncdentalboard.org."
Is there something I am missing?
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Never mind, I read it more closely and found it.
