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I don’t think, especially as a trainee, you should try and speak for an entire field. I think there are systemic issues here that need acknowledging whether you admit it or not.
Tragic death during dental procedure
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I don’t think, especially as a trainee, you should try and speak for an entire field. I think there are systemic issues here that need acknowledging whether you admit it or not.
I was duped? All this time I thought I was talking to someone who actually knows what he’s talking about?!
I dummy.
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deleted875186
Wow, learns anesthesia for 6 months during training, then claims because an oral surgeon does 6-8 surgical cases a day as fast as they can, with an assistant pushing versed, fentanyl, maybe propofol or ketamine, that they think they can handle deeper planes of anesthesia and airway complications better than an anesthesiologists. Simply shocking.
If dentists and oral surgeons cared about patients they would stop doing anything beyond mild-mod sedation in the office. It’s very clear, every anesthesiologists on this board would not want their family member to have this done, and many would not even consider working in a dental office doing these cases with oral surgeons because of the risk. We all know that the rate but predicted airway complication is not worth it.
If dentists and oral surgeons cared about patients they would stop doing anything beyond mild-mod sedation in the office. It’s very clear, every anesthesiologists on this board would not want their family member to have this done, and many would not even consider working in a dental office doing these cases with oral surgeons because of the risk. We all know that the rate but predicted airway complication is not worth it.
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Anesthesiology 101: The person responsible for monitoring the patient and the person responsible for the procedure should not be the same person.
Actually that guy just started residency in July. So chances are he's a gen surg intern at the moment and hasn't even done a day of anesthesia
Anesthesiology 201: There is a tremendous difference in knowing how to get out of trouble and avoiding that trouble in the first place.
But he's done 30 awake fibreoptics already!
Like if you're going to lie at least make it believable.
"Evidence based"? Have you actually read any if thr articles which you presented as evidence? What you mean is you read the summary paragraph and cherry pick some numbers that are actually extrapolations of estimates based on a recollection of events (literally the questionnaires asked how many anesthetics they think the dentist delivered in that year, then they multiple it by the number of years they practiced!! They then used data from those who responded to make sweeping generalizations about those who did not respond!!), combined with dubious reporting methods on 2 separate databases that interestingly did not have the same mortality events even though they were supposed to be comprehensive? Even the authors of your Canadian paper say so much. The authors also believe that improvements in training from 12 month to 36 month for dental anesthesiologists improved patient outcomes.. and Nevermjnd the fact that the study was based in Canada and not the United States. I doubt you know how to properly appraise research literature because rhe quality of your studies are... weak... to put nicely.
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Here are some real statistics, right out of the horses mouth: the CEO of the North Carolina board of dentistry reported 6 deaths related to dental anesthesia events in the last 7 years due to failure to uphold standard of care. Aka inadequate training, personnel, equipment. That's a single state, population of 10 million. These stats are a lot different than the laughably flawed Canadian study.
Apparently the dental board also feels that despite the alarming statistic this does not warrant more stringent regulation and dedicated anesthesia providers. In my mind this is proof that the dental board cannot be trusted to regulate its members or to keep the public safe.
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Everyone thinks they know more about anesthesia than the anesthesiologist.
Good luck to your future patients
Right up until they don’t. And we end up with the above. Wash. Rinse. Repeat.
When you make fake unsubstantiated claims it deserves a harsh rebuke.
This whole "but bad things also happen even when an anesthesia provider is present" seem to be a perennial favorite for some dentists, and the conclusion that you draw from jt is a logical fallacy.
Read what i wrote. I gave you a clear solution and you still don't get it.
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deleted87051
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deleted87051
It would be like me saying I’m qualified to practice internal medicine because I did a 1 year internal medicine internship back in 1992. I’m not qualified.
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1 year internship? By their logic, you are twice as qualified.
And better than a practicing internist because you've seen a few urgent care patients
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deleted641888
Well, I look at the ECG tracing at least every 5 minutes for 8-10 hours a day, so I’m pretty much equivalent to a cardiologist, but better, because I also provide the anesthetic while looking at the ECG. How many hours a day do cardiologists look at an ECG compared to us? Exactly. Evidence. Based.
I'm a family doctor so know next to nothing about dentistry or anesthesiology but if absolutely nothing else this seems like a pretty important principle.
Honestly a lot of this would probably be prevented if dentistry was treated like medicine for insurance.
Even “good” dental insurance usually has 50% co pay for anything outside of cleanings. That means patients are much more price sensitive then in medicine, hence in office sedation rather then surgery center, which would triple the cost.
Even “good” dental insurance usually has 50% co pay for anything outside of cleanings. That means patients are much more price sensitive then in medicine, hence in office sedation rather then surgery center, which would triple the cost.
Sorry. Totally not true. I had to have an implant and oral surgeon insisted I had to have iv sedation (out of pocket of course which i balked at as a poor resident at the time). Dentists friends thought it was overkill for what I needed. After a bunch of back and forth (including a negative yelp review), they agreed to do it local only. Afterwards the guy was like...youre the first patient I've done local with no sedation in 10 years. I was an ophthalmology resident. I do eye surgery on patients awake (and sometimes no sedation)
I'm not an oral surgeon so it's hard to comment on when iv sedation is necessary. But I was required by the doctor to have sedation for an implant for a lost molar and iv sedation for my particular case was simply not covered (patient pays 100% out of pocket)
This goes jnto the (?perverse) financial incentives that make dentists offer such high cost anesthesia services, not for medical necessitity but to give themselves a nicer paycheck.
The level of hubris here is amazing.
Having patients laryngospasm often and rescuing them often is not a sign of greatness. Anesthesia, when we do it well, looks like we're doing nothing at all. Beware the anesthesia "provider" who's frequently "skillfully" saving the day and managing complications. Real skill is avoiding dangerous situations and complications in the first place.
Also, the misused apostrophe is a data point.
Most of us do the ACLS recert every two years. If they're making you do it every year, they must think you need remediation.
He is calling out your penchant for making bold and wild claims that upon close scrutiny doesn't hold up. Just like your "evidence" of superior dental anesthesia outcomes. I mean the least you could do is actually read the study that you tout around like a trophy.
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deleted87051
15 years ago, my dentist retired so I went to a new dentist who told me all my fillings were bad and need to be replaced. I sought a 2nd opinion from another dentist who was highly recommended by one of our nurses. That dentist told me there was nothing wrong with my teeth. I still see him and there is still nothing wrong with my teeth. It’s wild out there in private offices with no oversight. Some places are awesome and some are super shady.
That really surprises me as well. Not sure how a dental assistant can be ACLS certified since most of ACLS (IV medications, advanced airway mgmt., defibrillation, etc.) are beyond their legal scope of practice.
well apparently in North Carolina every human in the state is sedated in a dental office on an annual basis based on the death toll
the problem seems to mostly be that you don't know what you don't know and you are in the wrong place trying to prove your competence.
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Extraordinary claims (oral surgeons with 6 months of anesthesia training are better anesthetists than board-certified anesthesiologists) require extraordinary evidence, and the studies you cite are certainly not that.
When an (ostensibly) healthy patient dies in what appears to be egregious circumstances in an oral surgeon's office, this is not the time to be chest beating and spewing the Kool-Aid you've apparently been mainlining since starting residency 8 months ago. It is time to be quiet and listen to what the rest of the medical community and the public are saying: this is not acceptable, and we expect better.
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This is laughable.
Arch Guillotti
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If you mess with the bull you get the horns
Quoting before you realize how stupid this entire paragraph is and edit it.
You don’t know what you don’t know. And you’re making an entire field look really, really stupid. As a first year resident. 😂😂😂
[emoji106] I believe you.
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This comment is so absurd it makes my head spin.
You’re using the term conscious sedation, and a few posts back moderate sedation liberally when what you are doing is actually deep sedation if not general anesthesia. You literally don’t understand the definitions for the depths of anesthesia. This gives me little confidence you have a clue.
And thinking 5-6 months of sedation heavy case volume among anesthesia residents during your training equates to being “more competent” than us is definitely delusional.
And to whoever posted typical case numbers and bragged about 250 intubations and 30 whole mask inductions is also party to the delusion.
"There has been concern in the OMFS community regarding the need to stock dantrolene when the only triggering agent present is succinylcholine and its use is very rare and frequently in low doses. Succinylcholine when used alone appears to be a very weak MH trigger. Informal pollings at meetings indicates that most providers of deep sedation in a dental office have never used succinylcholine to break a laryngospasm, so they do not stock dantrolene. Others believe that dantrolene should be kept even for this rare event." - Anesthesia Complications in the Dental Office (2015)
You are so out of your depth it's not even funny. Can't decide if you're not just trolling though.
You should also cite other works that other thread mentioned too, just to be complete.
Refer to post 122 and 123, which you conveniently ignore. Next time you cite evidence do a little more than look at the summary paragraph because it makes you look like a fool when the person you are trying to convince knows a lot more about the study's design, methodology and gaping flaws than you do.
ALSO You got it all backwards. YOU haven't provided any study that prove you claims.
We can play your game too. Prove to me that a dental hygienist isn't more qualified in dentistry than you are.
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The sad part of this is that I am very close with all our OMFS guys, and I really respect the work they do. And they have a very healthy appreciation for what my team does and the risks involved in complex OMFS work.
But please, preach on oh wise resident. I’m sure your attendings would be very proud.
But please, preach on oh wise resident. I’m sure your attendings would be very proud.
I did a TY, so I’m a qualified ER doctor, pediatrician, obstetrician, internist, neurologist, surgeon, urologist, and a psychiatrist. Not only am I qualified, but I’m way more competent in these specialties than their board certified specialists.
Oh, and one time in junior high, I rode a horse, so I’m a better bull rider than those amateurs in the PBR.
i pulled one of my tooth out when i was a kid. i might be more qualified than a dentist
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These are the same dental offices that are too cheap to buy adequate patient monitors and equipment. And you think they carry dantrolene?
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deleted87051
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Damn guys at least give OMFS resident dude some ketchup with all these harsh browns being thrown on his plate.
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deleted87051
Deep sedation with native airway while someone is working in the mouth is scary. They’re not as scary if you intubate them which is what I do unless they’re extracting 1 tooth that’s already loose. More often than not, our OMFS are extracting 6+ rotten teeth on some pre-SAVR or pre-TAVR patient with critical AS. For them I do the same induction as I would for the AVR or TAVR…preinduction Aline, pressors running or in-line, but with a nasal RAE. I can tell I’ve done the right thing when I’m not stressing during the case.
“If we had janitors doing the sedation for omfs, there may be some bad outcomes. But since bad outcomes happen every so often with anesthesiologists, it’s justified.”
Is this seriously the argument that’s being made?? What a joke.
That and omfs doing surgery in an unprotected airway while simultaneously monitoring the patient.. that’s always been stupid to me. I wonder if these dentists really think it’s safer because they are just doing sedation and not GA.
Is this seriously the argument that’s being made?? What a joke.
That and omfs doing surgery in an unprotected airway while simultaneously monitoring the patient.. that’s always been stupid to me. I wonder if these dentists really think it’s safer because they are just doing sedation and not GA.
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