Tragic death during dental procedure

[coffeebythelake]

The Public: dental sedation isn't safe

Anesthesiologists: dental sedation isn't safe

Dental anesthesiologists: literally a field created by dental organization because dental sedation isn't safe

Generic dental boards: hmmm may need to look into things more because it seems dental sedation may not be that safe

North Carolina dental board: 6 patients died in the last 7 years here from dental sedation. But don't worry... jt's not because dental sedation isn't safe. It's because our dentists like cutting corners and not following the standard of care due to inadequate personnel, training and equipment. (Read: Relax. The deaths are just because our dentists suck)

@bergus95: I may have a tiny fraction of the training in anesthesia and I have never actually independently taken care of a patient because I am a trainee but I know more than anyone else and I can operate while simultaneously delivering an anesthetic that is safer than anyone else including board certified anesthesiologists

Makes you wonder what goes on in a dentists head when they cut corners... 🤔

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[coffeebythelake]

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.

You are too generous. This case could easily be done with local and judicious dose of versed and fent.

 

[coffeebythelake]

It’s easy to create a duplicate thread with no substance. Funny how none of you are laughing it up with jokes and comments with Oral Surgeons in practice but had to hide out here.

I’m enjoying it, but I’d be more interested in the debate on the other thread.

Let's see. 2 admins and plenty of seasoned university faculty anesthesiologists (and many others) on this forum have dismissed you for making ridiculous and laughable comments. What we conclude is that you are too lazy to actually read the research papers you cite as evidence, and you are blind to facts about actual verifiable death rates due to dentist-led anesthesia care that are orders of magnitude higher than you claim. Moreover you are a trainee who has never actually independently taken care of a patient or given anesthesia. And with your arrogance and hubris it should stay that way. I think that says plenty about someone with no substance. 🤣🤣🤣

Tell your dentist friends to come here and have a real debate with the experts. But we won't be sad to see you go.

 

[Dantrolene FC]

Can anyone think of a reason you would use both isoflurane and sevoflurane? Isn’t it standard in anesthesiology that our machines do not allow that?

Family of Edmonton girl who suffered brain damage after dental visit sues for $26.5 million

Amber Athwal, now five years old, stopped breathing at some point, which was noticed at 12:15 p.m. on Sept. 7, 2016 while the girl was in recovery.

edmontonjournal.com

 

[Onefellswoop87]

Can anyone think of a reason you would use both isoflurane and sevoflurane? Isn’t it standard in anesthesiology that our machines do not allow that?

Family of Edmonton girl who suffered brain damage after dental visit sues for $26.5 million

Amber Athwal, now five years old, stopped breathing at some point, which was noticed at 12:15 p.m. on Sept. 7, 2016 while the girl was in recovery.

edmontonjournal.com

All machines that I’ve worked with will not allow simultaneous coadministrarion of different volatile. Did he mask with sevo and switch to iso? As with most of these news articles, missing a lot of info.

 

[Dantrolene FC]

All machines that I’ve worked with will not allow simultaneous coadministrarion of different volatile. Did he mask with sevo and switch to iso? As with most of these news articles, missing a lot of info.

That would make more sense.

 

[coffeebythelake]

All machines that I’ve worked with will not allow simultaneous coadministrarion of different volatile. Did he mask with sevo and switch to iso? As with most of these news articles, missing a lot of info.

Some older machines do not have the mechanism to restrict coadministration of volatile agents. Or maybe faulty machine not well maintained?

On top of everythjng else wrong with that case the patient was not appropriately NPO for the procedure and should not have been allowed to proceed (per reports the case began at 11 am and patient had bread and breakfast that morning). The anesthetic gas "sedation" was administered by the dentist. Sad. just another example of dentists having inadequate training, and lax safety protocols.

The dentist Mather was found guilty of multiple charges of professional misconduct (he pled no-contest to 3 charges of "serious breeches of his professional and ethical duties") and settled the $26.5 million lawsuit. He retired shortly after this incident.. what a way to end his career. His nurse was also found guilty of professional misconduct and license revoked. The patient seems to have made some recovery.

 

[Onefellswoop87]

Some older machines might not have the mechanism to restrict coadministration of volatile agents. On top of everythjng else wrong with that case the patient was not appropriately NPO for the procedure and should not have been allowed to proceed (per reports the case began at 11 am and patient had bread and breakfast that morning). Sad and just another example of dentists not knowing what they are doing.

That timing caught my eye too. Even calling the bread and milk a light meal, that would mean the kid finished breakfast at 5am. Lots of red flags, I agree

 

[Gern Blansten]

How often do you see laryngospasm? And since it sounds like you have so much experience can you explain to us your tricks for treating it?

User name checks out.

 

[2TH MVR]

Is the medical community accepting of dental anesthesiologists or do they represent additional turf war issues?

 

[Ronin786]

I've practiced at office practices that "stock sux". It's usually one vial in a fridge hidden behind other meds. It's there in name alone.

I did one day there and never plan on returning. And this was with a stocked anesthesia cart. The pressure to just let things go because patients are generally healthy and cases short is very high. And if things go south, you're on your own.

 

[coffeebythelake]

Is the medical community accepting of dental anesthesiologists or do they represent additional turf war issues?

While dental anesthesiologist may not have the same depth and breadth of training that a physician anesthesiologist has (they wouldn't do hearts, icu, obstetrics, regional, trauma or transplant anesthesia for instance and likely have limited experience in things such as placing art lines, central lines, interpreting labs and studies, etc), their training far exceed that of other dentists in anesthesia is appropriate for their role in a dental office based setting (vigilance and monitoring, responding to emergencies, advanced airway management, etc). They check all the boxes for a qualified anesthesia provider and improve safety. I'm not sure what "turf war" you refer to, as a dental anesthesiologist would never do the work I do and I don't intend to do the office based stuff that they do.

 

[Dantrolene FC]

If optho has anesthesia present for cataracts, is it unreasonable to have anesthesia present for dental?

 

[GassYous]

How about a CRNA?

Weren't you leaving the thread or something

Don't even have any papers stating that anbuitachi isn't better than you at dentistry

 

[IMGASMD]

Is the medical community accepting of dental anesthesiologists or do they represent additional turf war issues?

I am not one. But I’d assume it sort of plays out this way too. There are even fewer of them. Someone did mention recently there are like less than 20 that graduates every year. Also they’re treated like pariah within their own dental community. I remember some went as far as calling them incompetent dentists, therefore transition to anesthesia.

You have the OMSF on one side, who claims they are able to do both (surgery and giving anesthesia) perfectly and anesthesiologists on the other side, unable to verify their training.

But I think the fact that they have a “speciality” dedicated to anesthesia speaks for itself.

 

[anbuitachi]

Some older machines do not have the mechanism to restrict coadministration of volatile agents. Or maybe faulty machine not well maintained?

On top of everythjng else wrong with that case the patient was not appropriately NPO for the procedure and should not have been allowed to proceed (per reports the case began at 11 am and patient had bread and breakfast that morning). The anesthetic gas "sedation" was administered by the dentist. Sad. just another example of dentists having inadequate training, and lax safety protocols.



View attachment 349764

The dentist Mather was found guilty of multiple charges of professional misconduct (he pled no-contest to 3 charges of "serious breeches of his professional and ethical duties") and settled the $26.5 million lawsuit. He retired shortly after this incident.. what a way to end his career. His nurse was also found guilty of professional misconduct and license revoked. The patient seems to have made some recovery.

what happens when a dentist or any doctor, settles a lawsuit for 26.5M.... what is there to retire on.. how do you even pay that much when insurance mostly cover 1M. who has 26M sitting around?

 

[Robotic Wis-Hipple]

If optho has anesthesia present for cataracts, is it unreasonable to have anesthesia present for dental?

I’m sure most of us have done countless cataracts or other eye case days. The vast majority of eye surgeries are done with topicalization (eye drops) or perhaps bulbar blocks, many if not most get literally zero IV medications or perhaps 1mg of versed for anxiolysis (not sedation). And yet, Optho wishes us there so that they can focus on the procedure and know that if something were to happen there was someone there to do something about it.

But I imagine pgg’s theory can be applied/is in play here….

 

[CHARLESTONMMM]

Now I know what you guys do when you’re on your phones all day.

But you’re right, I’m enjoying the good life you’d never dream of prematurely.

Have fun enjoying your specialty getting encroached on by mid level providers and getting some gusto back by clapping back at a 1st year resident with a dental degree. Big strong man you are!

I bet you’re fun at parties.

 

[NITRAS]

WTH did I just read. . .

 

[GassYous]

 

[nimbus]

Can anyone think of a reason you would use both isoflurane and sevoflurane? Isn’t it standard in anesthesiology that our machines do not allow that?

Family of Edmonton girl who suffered brain damage after dental visit sues for $26.5 million

Amber Athwal, now five years old, stopped breathing at some point, which was noticed at 12:15 p.m. on Sept. 7, 2016 while the girl was in recovery.

edmontonjournal.com

Maybe they induced with sevo, then switched to iso for maintenance.

 

[chessknt]

It is a good thing that dentists in general aren’t overconfident bros like the troll in this thread otherwise this would be far more common… I do have serious concerns about future patients that he operates on however. Maybe time will season him but the level of arrogant assumption here is usually selected against in the medical training process because of how dangerous it is. Clearly the system failed in his case.

 

[D1Bound]

Can someone link me a peer reviewed study demonstrating that Oral and Maxillofacial surgeons doing anesthesia is either safe (low amount of deaths) or unsafe (many deaths)

 

[murdoc9]

Now I know what you guys do when you’re on your phones all day.

But you’re right, I’m enjoying the good life you’d never dream of prematurely.

Have fun enjoying your specialty getting encroached on by mid level providers and getting some gusto back by clapping back at a 1st year resident with a dental degree. Big strong man you are!

Right. So you concede you're a 1st year resident with a dental degree. That's progress!

But in all seriousness, it makes me sad to see discourse like this from a brand new trainee. As a new attending, I stay humble and constantly seek to grow my knowledge and experience. I think everyone wants to take the best care of patients at the end of the day.

But instead you decide to denigrate an entire specialty based on your 6 month anesthesia tutorial. You don't seem to have the maturity to admit that you don't know what you don't know, and that is the scariest part.

Also, we've had CRNAs forever. Nothing new there. If anything I'd consider how midlevels might impact your field going forward, as that is the way of the future in healthcare in general.

 

[Urzuz]

Am I the only one that just doesn’t care how the OMFS / dental community polices themselves vis a vis anesthetic administration? Our demand is high enough as it is, both in and out of hospitals, and the last thing I want to start doing is covering every dental practice around the country. If an OMFS/dentist wants an anesthesiologists help, great. If not, have at it. They are professionals. Let them draw their own conclusions to what’s necessary or not. Of course if you’re asked to provide your expert opinion on whether something is safe or not, you can give your professional opinion. You can also vote with your feet and refuse to go to an OMFS that doesn’t have an anesthesiologist present.

Quite frankly I view it in the same way I view sedation in the ED - they are professionals, let them do whatever they want. I have no desire to hold their hands and be their parent. If they want our help or need our help in the future, they’ll ask for it. Until that time, let them do whatever they want, weigh in when necessary, and do whatever you feel is right to keep yourself and your loved ones safe.

 

[coffeebythelake]

Can someone link me a peer reviewed study demonstrating that Oral and Maxillofacial surgeons doing anesthesia is either safe (low amount of deaths) or unsafe (many deaths)

You are a dentist. You should know better than me the data that exists and what doesn't. A lack of this "peer reviewed study" that you are looking for should not imply (and hopefully not what you are trying to insinuate) that everything is perfectly safe when so many anecdotes, individual cases, and news reports suggest otherwise.

You don't need and you probably won't find peer reviewed studies on basic statistics like number of deaths. Dental boards have been hiding behind the opacity of reporting such events for decades making any meaningful assessment of mortality % difficult to ascertain (if both both numerator and denominator are both extrapolations of estimates based on some fantastical assumptions, the degree of confidence is going to be very poor). And it is upon this that our OMFS newbie extraordinare @bergus95 hung his hat on, claiming a death rate of less than 1 in a million based, without so much as actually reading the methodology or limitations of the study.

What we do have are official numbers that are given out by dental boards every once in a while when a really egregious case happens, the public is outraged, and the veil is briefly lifted to show how shady office based dental practices can be. This is how we know that in the last 7 years there have been 6 deaths in North Carolina relating to dentist-led dental sedation which by the own words of the board is due to failure to follow standards of care. I don't have data at this time to confirm about other states, but I wouldn't be surprised if this alarmjng statistic is representative of the country as a whole.

 

[coffeebythelake]

what happens when a dentist or any doctor, settles a lawsuit for 26.5M.... what is there to retire on.. how do you even pay that much when insurance mostly cover 1M. who has 26M sitting around?

Good question, not sure how much of it is covered by his insurance and how much he paid out from his own assets. But imagine working 40 years and basically having the cumulative gains from years of work taken from him because he thought he could cut some corners in patient safety to save some money. Talk about penny rich pound foolish.

 

[Saddleshoes]

I just read through the whole thread...
As a dentist I have to add one thing to this conversion. You guys cannot believe the pressure we dentists face from our patients to be "Put to sleep" for simple dental work.
(My answer has always been, "If you need to be put to sleep your going to have to go somewhere else.")

 

[shepardsun]

(My answer has always been, "If you need to be put to sleep your going to have to go some where else.")

Kudos to you. This pressure isn't exclusive to your profession and arises due to 1. the infantilization of the American adult and 2. the customer service mentality of healthcare in general.

We are victims of our own success in so many ways with how "easy" and "safe" we make most anesthetics look, which then enables surgeons, schedulers, and patients to feel entitled to request it for in my view inappropriate reasons.

Adults don't need 22 g PIVs. Cataracts don't need the administration of respiratory depressant sedatives. MRIs don't need general anesthesia. I used to try to convey to the morbidly obese claustrophobe that their risk of suffering serious injury or death in the MRI scanner under general anesthesia could be higher than in the main OR having a bigger case done given the remote location, lack of tools, and experienced personnel should an airway emergency arise.

It went in one ear and out the other and I stopped doing it because the average person wants to avoid any uncomfortable situation whatsoever no matter the implications.

 

[Onefellswoop87]

Wait what? "anecdotes, individual cases, and news reports" is what you are hanging your claims on. Regardless of this debate, I would expect more.

Dental boards have not been hiding the opacity of these events. The vast vast majority of dentists are not doing IV sedation.

Lets back it up

December of 1844 is when Dr. Horace Wells, a dentist, first demonstrated that volatile gases could be inhaled and used for medical and dental anesthesia. Oral and Maxillofacial Surgeons have been the recognized leaders among the nation’s dental and medical professionals for the delivery of safe and effective outpatient anesthesia

The history of oral and maxillofacial surgery office-based anesthesia parallels the emergence of the medical hospital model when, in the 1930’s, Dr. John Lundy, who first developed and used the IV pentothal technique at the Mayo clinic, taught the new IV procedure to Mayo’s Chief of Oral Surgery, Dr. Ed Staffney. Dr. Staffney, in turn, ensured that all oral surgery residents at the Mayo Clinic were taught IV pentothal anesthesia as part of their clinical training. The Mayo Clinic’s senior oral surgery resident at that time was Adrian Hubble, who went on to teach this technique to oral surgeons across United States.

OMFS and office based anesthesia dates back to close to a century

As far as some reading for you

Perrott DH, Yuen JP, Andresen RV, Dodson TB. Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2003;61:983-995

Lytle JJ, Yoon C. 1978 anesthesia morbidity and mortality survey: Southern California Society of Oral and Maxillofacial Surgeons. J Oral Surg. 1980;38:814-819.

Lytle JJ. Anesthesia morbidity and mortality survey of the Southern California Society of Oral Surgeons. J Oral Surg. 1974;32:739-744.

Lunn JN, Mushin WW. Mortality associated with anaesthesia. Anaesthesia. 1982;37:856.

Anesthesia and Sedation in the Dental Office. NIH Consensus Statement. 1985 Apr 22-24;5:1-18. Available at: http://consensus.nih. gov/1985/1985AnesthesiaDental050html.htm. Accessed September 1, 2016

Steven J Wiemer et al. Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019). May 2021. J Oral Maxillofac Surg

And lastly some antedotes, individual stories, and news articles of tragic deaths by anesthesiologists and CRNAs in dental settings

Parents of student who died after dental surgery sue for malpractice

The mother of a Woodstock teenager who died after experiencing hypoxia during a routine wisdom teeth removal surgery is now suing for medical malpractice the team…

www.baltimoresun.com

Lawsuits filed against Arizona nurse anesthetist after two dental deaths, fire in mouth

An Arizona nurse anesthetist is facing multiple lawsuits after two of his patients died in separate dental procedures within a year.

www.abc15.com

Though I appreciate you rehashing the first chapter of any anesthesia textbook, isn’t using the historical claim that Horace Wells was a dentist the same logic as arguing that the barber shop I’m about to take my son to should perform his appendectomy?
We are talking about recent events as a problem with safety trends and splitting your focus between two complex tasks: surgery and anesthesia - not history of current affairs.

 

[greatnt249]

Now I know what you guys do when you’re on your phones all day.

But you’re right, I’m enjoying the good life you’d never dream of prematurely.

Have fun enjoying your specialty getting encroached on by mid level providers and getting some gusto back by clapping back at a 1st year resident with a dental degree. Big strong man you are!

Classic...storm into a discussion claiming/implying expertise in a subject, then when met with confrontation by actual experts in the field, hide behind the veil of a novice being unjustly victimized by experts just looking to assert their authority at any given chance.

 

[schmoob]

Does every dental office carry Dantrolene for their Sux?

No.
But we have something even better. We have this awesome cream that we place on the injection site to make the injection less uncomfortable.

Yes

No. My office had a visiting oral surgeon. We had plenty of succ but zero dantrolene.

Dude you need to read the room. You are a trainee being provided advice from attendings. Kind of like a residency? You are in no position. To “school” them.
I extract teeth all the time, to include partial and full bony’s. That doesn’t make me an oral surgeon. I also do all of my own root canals, so does that make me an endodontist? Or even better yet you can say I perform microvascular neurosurgery.

Imagine a first year dental student trying to argue with you on a topic they know nothing about.

Can someone link me a peer reviewed study demonstrating that Oral and Maxillofacial surgeons doing anesthesia is either safe (low amount of deaths) or unsafe (many deaths)

You have PubMed access.

I just read through the whole thread...
As a dentist I have to add one thing to this conversion. You guys cannot believe the pressure we dentists face from our patients to be "Put to sleep" for simple dental work.
(My answer has always been, "If you need to be put to sleep your going to have to go somewhere else.")

Absolutely. I’ll offer some Halcion but beyond that I’ll send the patients out.

 

[coffeebythelake]

Wait what? "anecdotes, individual cases, and news reports" is what you are hanging your claims on. Regardless of this debate, I would expect more.

Dental boards have not been hiding the opacity of these events. The vast vast majority of dentists are not doing IV sedation.

Lets back it up

December of 1844 is when Dr. Horace Wells, a dentist, first demonstrated that volatile gases could be inhaled and used for medical and dental anesthesia. Oral and Maxillofacial Surgeons have been the recognized leaders among the nation’s dental and medical professionals for the delivery of safe and effective outpatient anesthesia

The history of oral and maxillofacial surgery office-based anesthesia parallels the emergence of the medical hospital model when, in the 1930’s, Dr. John Lundy, who first developed and used the IV pentothal technique at the Mayo clinic, taught the new IV procedure to Mayo’s Chief of Oral Surgery, Dr. Ed Staffney. Dr. Staffney, in turn, ensured that all oral surgery residents at the Mayo Clinic were taught IV pentothal anesthesia as part of their clinical training. The Mayo Clinic’s senior oral surgery resident at that time was Adrian Hubble, who went on to teach this technique to oral surgeons across United States.

OMFS and office based anesthesia dates back to close to a century

As far as some reading for you

Perrott DH, Yuen JP, Andresen RV, Dodson TB. Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2003;61:983-995

Lytle JJ, Yoon C. 1978 anesthesia morbidity and mortality survey: Southern California Society of Oral and Maxillofacial Surgeons. J Oral Surg. 1980;38:814-819.

Lytle JJ. Anesthesia morbidity and mortality survey of the Southern California Society of Oral Surgeons. J Oral Surg. 1974;32:739-744.

Lunn JN, Mushin WW. Mortality associated with anaesthesia. Anaesthesia. 1982;37:856.

Anesthesia and Sedation in the Dental Office. NIH Consensus Statement. 1985 Apr 22-24;5:1-18. Available at: http://consensus.nih. gov/1985/1985AnesthesiaDental050html.htm. Accessed September 1, 2016

Steven J Wiemer et al. Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019). May 2021. J Oral Maxillofac Surg

And lastly some antedotes, individual stories, and news articles of tragic deaths by anesthesiologists and CRNAs in dental settings

Parents of student who died after dental surgery sue for malpractice

The mother of a Woodstock teenager who died after experiencing hypoxia during a routine wisdom teeth removal surgery is now suing for medical malpractice the team…

www.baltimoresun.com

Lawsuits filed against Arizona nurse anesthetist after two dental deaths, fire in mouth

An Arizona nurse anesthetist is facing multiple lawsuits after two of his patients died in separate dental procedures within a year.

www.abc15.com

Are you incapable of reading more than a few sentences? Do you have a learning disability? Let me keep my responses to you short as it seems you are unable to coherently synthesize information. In that same post I gave real statistics provided by your own dental boards and it is alarmingly high. It is also the third time I've given you this verifiable and highly reliable statistic, which amounts to a mortality rate (at least in this state) an order of magnitude or higher than what you think. It is not made up BS that you tout around.

I think this post from earlier says it all.

Don't play the victim card after you jump on an anesthesiologist forum trying to provoke a fight. You see that peak on the far left of this graph? That's you.

 

[Robotic Wis-Hipple]

I just read through the whole thread...
As a dentist I have to add one thing to this conversion. You guys cannot believe the pressure we dentists face from our patients to be "Put to sleep" for simple dental work.
(My answer has always been, "If you need to be put to sleep your going to have to go somewhere else.")

Oh, I think we can all believe the pressure from patients.

Everyone wants to be totally asleep for everything especially things like colonoscopies etc. Our patients want to be asleep before they even enter the OR. Everyone wants an easy button for everything that may be potentially unpleasant. So we get it. But healthcare delivery isn’t a Burger King order. The devil is in the details and the job is providing the care a patient needs in the most appropriate way.

I just saw @shepardsun make this point more eloquently than I.

 

[Robotic Wis-Hipple]

@bergus95

I honestly think Anesthesiologists as a whole would sum up our position on this with the following two statements:

1. The Proceduralist should not also be the person in charge of the sedation and vitals monitoring.

2. From the ASA;

“Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. Individuals administering Moderate Sedation/Analgesia (‘Conscious Sedation’) should be able to rescue patients who enter a state of Deep Sedation/Analgesia, whilst those administering Deep Sedation/Analgesia should be able to rescue patients who enter a state of General Anesthesia. Rescue of a patient from a deeper level of sedation than intended is an intervention by a practitioner proficient in airway management and advanced life support. The qualified practitioner corrects adverse physiologic consequences of the deeper-than-intended level of sedation (such as hypoventilation, hypoxia and hypotension) and returns the patient to the originally intended level of sedation.”

And I personally maintain that you don’t even know the definitions let alone the implications of the varying levels of sedation/anesthesia as it applies to level of patient interaction, airway reflexes, and ventilatory drive. And as that is the minimum bar for entry you are wholly unqualified to discuss this further.

 

[coffeebythelake]

How about a CRNA?

I would trust a CRNA 100x more than you to give a safe anesthetic.

 

[Straight2eight]

Don’t feed the troll. It seems to be taking up residence…

 

[Mman]

1. The Proceduralist should not also be the person in charge of the sedation and vitals monitoring.

Emergency medicine as a specialty agrees with this when they are sedating for procedures in the ED.

 

[schmoob]

Moderators, please consider closing this thread. There are comments being made here that are not helpful nor professional.

This forum and its threads are not like the dental forums. If you do not like it, feel free to see yourself out. In fact, as a second year dental student in a practicing anesthesiology forum, I highly encourage it.

 

[ValentineD]

@bergus95
“Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. Individuals administering Moderate Sedation/Analgesia (‘Conscious Sedation’) should be able to rescue patients who enter a state of Deep Sedation/Analgesia, whilst those administering Deep Sedation/Analgesia should be able to rescue patients who enter a state of General Anesthesia. Rescue of a patient from a deeper level of sedation than intended is an intervention by a practitioner proficient in airway management and advanced life support. The qualified practitioner corrects adverse physiologic consequences of the deeper-than-intended level of sedation (such as hypoventilation, hypoxia and hypotension) and returns the patient to the originally intended level of sedation.”

"Anesthesia STAT to cath lab. Anesthesia STAT to cath lab."

Cath lab nurse: But I gave him the normal dose!

 

[GassYous]

"Anesthesia STAT to cath lab. Anesthesia STAT to cath lab."

Cath lab nurse: But I gave him the normal dose!

Been there!

 

[greatnt249]

Again, you chose to sit and argue with a first year resident versus challenging these notions on the original thread. Showing me the dunning-kruger effect graph is not a valid argument. Telling me that in your state (which in of itself might be an outlier), does not provide real statistics.

Thank you for proving my previous point further. A little humility in medicine goes a long way. You should be humbled in some way every day when you are practicing medicine; routine becomes very "not routine" in a hurry if you aren't constantly vigilant.

 

[coffeebythelake]

Again, you chose to sit and argue with a first year resident versus challenging these notions on the original thread. Showing me the dunning-kruger effect graph is not a valid argument. Telling me that in your state (which in of itself might be an outlier), does not provide real statistics.

More death statistics, including the some of the most populous states in the country:

California - 55 dental sedation deaths originally reported by the Dental Board of California over 4 years (which they later revised to 24 deaths over this period after requests were made for further information.)

Texas - 85 dental sedation deaths from 2010 to 2016

New York - at least 31 dental sedation deaths from 2004 to 2013, based on insurance payout data for deaths

North Carolina - 6 deaths from 2014 to 2021, from the CEO of the North Carolina dental board.






I'm posting this for information so the public looking up dental sedation deaths can see:

1. the mortality risk for dental sedation ("1 in a million") quoted by dentists significantly downplays the risk involved,

2. the alarmingly high mortality risk with dental sedation can often be attributed to inappropriate level of training, monitoring and lax standards of care



“It sure looks like they [dental boards] are trying to cover up something,”
- Dr Mashni, DDS practicing dentist and past president of the American Society of Dentist Anesthesiologists

 

[IlDestriero]

I think the conversation ended when you said you were better at providing sedation than an experienced board certified anesthesiologist. That’s the attitude that kills people. Out!

 

[coffeebythelake]

Emergency medicine as a specialty agrees with this when they are sedating for procedures in the ED.

not to mention they exist in hospitals with medical standards of care, monitoring, training, personnel and drugs
people who know how to intubate and resuscitate after
people who have a healthy respect for the dangers of sedation,
access to higher acuity care when things go south including icu, anesthesia staff

 

[vector2]

. But I can tell you with certainty that every OMFS is more competent at handling these moderate sedations than most CRNA's and anesthesiologists

A couple days a week I have to do bariatric endo where 400lb people with multiple comorbidities get deeeeep sedation (i.e. an unprotected airway general anesthetic) while an endoscope is shoved down their redundant tissue-laden gullets.

Any of your OMFS buddies have some sedation tips for a lowly board certified anesthesiologist like me?

 

[D1Bound]

A couple days a week I have to do bariatric endo where 400lb people with multiple comorbidities get deeeeep sedation (i.e. an unprotected airway general anesthetic) while an endoscope is shoved down their redundant tissue-laden gullets.

Any of your OMFS buddies have some sedation tips for a lowly board certified anesthesiologist like me?

Na, too busy shucking wizzies my friend

 

[coffeebythelake]

A summary of @bergus95's posts and my commentary (most cringeworthy in red)

We have a great safety track-record historically with death/adverse complication approaching 1 in 750,000 to 1,000,000 anesthetics administered.

False claim, based on this study Mortality and Morbidity in Office-Based General Anesthesia for Dentistry in Ontario
Available information shows that the serious "adverse complication rate" (non-fatal heart attack, stroke, aspiration, other injuries relating to the dentist's actions) requiring hospitalization is about 6x higher than the death rate data.

the numbers are out there.

Mortality and Morbidity in Office-Based General Anesthesia for Dentistry in Ontario

Our objective was to estimate the prevalence of mortality and serious morbidity for office-based deep sedation and general anesthesia (DS/GA) for dentistry in Ontario from 1996 to 2015. Data were collected retrospectively in 2 phases. Phase I involved ...

www.ncbi.nlm.nih.gov

Death Rate of Dental Anaesthesia

Death was the most important side effect of anaesthesia in dentistry. In this article we reviewed more than 20 studies with adequate data focusing on death associated with dental procedures since 1955 and found 218 deaths out of 71,435,282 patients (3 ...

www.ncbi.nlm.nih.gov

False. See my rebuttal.

Actually doing them on a dummy patient. No different than we do in ACLS every year.

Your comment about how you practice for emergencies.

Find my a study that contradicts these and you have a point.

I've given you the death statistics from multiple states that absolutely contradict what you wrote.

But I can tell you with certainty that every OMFS is more competent at handling these moderate sedations than most CRNA's and anesthesiologists.

Laughable.

Following our 6 months of anesthesia training, we don't just stop.

You understand that AA's and CRNA's have 2 years of anesthesia training, dental anesthesiologists have 3 years, and anesthesiologists have at least 4 years? Claiming that 6 months make you qualified is a joke.

Show me the numbers

OK. here they are: Tragic death during dental procedure

An OMFS who does 5-10 sedations daily, and did them much more frequently during residency is going to be much more competent than any other [anesthesia] provider who does them a few times a week/month, if that.

HAHAHAHAHAHAHAHA

how do you get real life experience dealing with an emergency? when it comes up.

how does an oral surgeon? when it comes up.

Actually you don't deal with emergencies by fumbling around when it comes up.

Really thought provoking conversations you are striving for.

My points are evidence based.

What evidence?

Leaving this thread now

Why are you still around?

About whether every dentist office carries dantrolene: an unqualified "Yes"

To which a practicing dentist writes: no we don't.
Well that must be embarrassing for you.

It’s easy to create a duplicate thread with no substance. Funny how none of you are laughing it up with jokes and comments with Oral Surgeons in practice but had to hide out here.

I’m enjoying it, but I’d be more interested in the debate on the other thread.

I find it amusing that you tried to pull some dentists to come over here and defend you but they haven't.

Telling me that in your state (which in of itself might be an outlier), does not provide real statistics.

The basis of debate is that both sides have a point. You are plain wrong and can't accept it. I've been waiting for you to finally acknowledge and ask about real statistics. Got some stats from California, New York, Texas, and others.


(Sorry guys I just can't help feeding the troll)

 

[Arch Guillotti]

Na, too busy shucking wizzies my friend

No idea what that means. Everyone take a deep breath.

 

[D1Bound]

No idea what that means. Everyone take a deep breath.

Best kept secret muahaha 🤫