Tragic death during dental procedure

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Mman said:
the worst outcome you should ever really get with laryngospasm is negative pressure pulmonary edema. That can develop very quickly in the right patient even if you recognize and treat appropriately. But that isn't going to kill them.
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I’m not a big sux fan but I’ll pull it out when I think the patient is at risk of going down that route. Typically a strong healthy patient/closed glottis/good resp effort.
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Radetzky said:
Arrives at disaster- “ive only given 10 of versed” 🤦‍♂️
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conscious sedation nurses are restricted to only versed and fentanyl, and still patient safety issues like this come up from time to time.
seen it happen in EP, seen it happen in GI lab, seen it happen in bronch suite.
 
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Just another reminder that the worst qualities of healthcare are represented by "proceduralists" like this. Not even the dumbest and biggest diva surgeons exhibit the level of hubris regularly shared about these folks.
 
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Neopolymath said:
Just another reminder that the worst qualities of healthcare are represented by "proceduralists" like this. Not even the dumbest and biggest diva surgeons exhibit the level of hubris regularly shared about these folks.
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Very high profile plastic surgery deaths have recently occurred. Reading the account of the events were pretty amazing.
 
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coffeebythelake said:
slash trach? wonder if the dentist even knows where to cut? they have scalpels? What happened to good ol' mask ventilation?
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This is a long thread. Some really good info and legitimate concerns. I will say I appreciate many of the comments regarding this issue.
But sadly, there are several very unprofessional comments on here. And some are actually pretty uninformed and laughable.

This comment above is my favorite in particular.
My opinion? An oral surgeon uses a scalpel more times in 1 day than “coffeebythelake”has in their entire career. I think that’s something we can all agree on !
 
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Eli Manning said:
This comment above is my favorite in particular.
My opinion? An oral surgeon uses a scalpel more times in 1 day than “coffeebythelake”has in their entire career. I think that’s something we can all agree on !
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A dermatologist uses a scalpel all day long and I would not trust them to do an emergency cric/trach if needed
 
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Eli Manning said:
This is a long thread. Some really good info and legitimate concerns. I will say I appreciate many of the comments regarding this issue.
But sadly, there are several very unprofessional comments on here. And some are actually pretty uninformed and laughable.

This comment above is my favorite in particular.
My opinion? An oral surgeon uses a scalpel more times in 1 day than “coffeebythelake”has in their entire career. I think that’s something we can all agree on !
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The fact that even an oral surgeon failed to successfully mask ventilate, intubate, perform a cric or trach, or perform CPR on Patel is all the more reason that they should not be performing anesthesia and procedures simultaneously
 
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Eli Manning said:
This is a long thread. Some really good info and legitimate concerns. I will say I appreciate many of the comments regarding this issue.
But sadly, there are several very unprofessional comments on here. And some are actually pretty uninformed and laughable.

This comment above is my favorite in particular.
My opinion? An oral surgeon uses a scalpel more times in 1 day than “coffeebythelake”has in their entire career. I think that’s something we can all agree on !
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Laughable is your idea that a slash trach would even be appropriate in this situation. It isn't. The dentist failed to mask ventilate, failed to intubate, and apparently also failed to do an emergency surgical airway. Like everyone hetr has said this is almost certainly hypoxemic arrest from laryngospasm or hypopnea/apnea from oversedation. But good for you for holding on to the idea that you are a master of emergency trachs because you've held a scalpel before. 🤪
 
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coffeebythelake said:
Laughable is your idea that a slash trach would even be appropriate in this situation. It isn't. The dentist failed to mask ventilate, failed to intubate, and apparently also failed to do an emergency surgical airway. But good for you for holding on to the idea that you are a master of emergency trachs because you've held a scalpel before. 🤪
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wow you took what I said and turned it 180 degrees around. You’re a clown. I never said the situation was laughable or that the slash trach was appropriate. In fact I’m not even commenting on the situation regarding the death of that patient. My comment is directed to you as a person.

I just think it’s absurd that you think an oral surgeon doesn’t know what a scalpel is. And by that I mean you have probably never held a scalpel in your hand but maybe 5 times in your career. Assuming you are actually an attending like your profile says and not an actual clown like you seem.

Does your rubber nose fit behind your mask? Do the surgeon booties fit over your clown shoes?
 
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Eli Manning said:
wow you took what I said and turned it 180 degrees around. You’re a clown. I never said the situation was laughable or that the slash trach was appropriate. In fact I’m not even commenting on the situation regarding the death of that patient. My comment is directed to you as a person.

I just think it’s absurd that you think an oral surgeon doesn’t know what a scalpel is. And by that I mean you have probably never held a scalpel in your hand but maybe 5 times in your career. Assuming you are actually an attending like your profile says and not an actual clown like you seem.

Does your rubber nose fit behind your mask? Do the surgeon booties fit over your clown shoes?
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Ok, ok Eli. You’ve seen and used a scalpel before. We now know you’re not “just” a dentist. Any other points you’d like to make while here?
 
Mman said:
A dermatologist uses a scalpel all day long and I would not trust them to do an emergency cric/trach if needed
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I actually assumed that a certain number of tracheostomies would be part of their training requirements, but apparently it's not. That being said I do know some of the OMFS I work with in the hospital (one of them being head and neck fellowship trained) are capable of them however I'm assuming that's not the norm though esp for the mostly office-based ones.

 
vector2 said:
I actually assumed that a certain number of tracheostomies would be part of their training requirements, but apparently it's not. That being said I do know some of the OMFS I work with in the hospital (one of them being head and neck fellowship trained) are capable of them however I'm assuming that's not the norm though esp for the mostly office-based ones.

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2 of ours do trachs too. Interesting thing about them is that they are both very careful and request cardiac anesthesia for their pre-TAVR and Pre-SAVR patients when we (the anesthesia department) don’t think it’s indicated since we all take care of severe AS patients.
 
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Eli Manning said:
wow you took what I said and turned it 180 degrees around. You’re a clown. I never said the situation was laughable or that the slash trach was appropriate. In fact I’m not even commenting on the situation regarding the death of that patient. My comment is directed to you as a person.

I just think it’s absurd that you think an oral surgeon doesn’t know what a scalpel is. And by that I mean you have probably never held a scalpel in your hand but maybe 5 times in your career. Assuming you are actually an attending like your profile says and not an actual clown like you seem.

Does your rubber nose fit behind your mask? Do the surgeon booties fit over your clown shoes?
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I don’t think his comments were made to disrespect all oral surgeons, many that I have worked with are all excellent, they work next to anesthesiologists all day and frequently operate with ENT doctors.

But the idea that an “emergency trach” is in their wheelhouse is ridiculous. The idea that an outpatient oral surgeon doing wisdom teeth all day is competent to handle general anesthesia while simultaneously performing a surgery is also ridiculous for many reasons. And as most have pointed out, the office setup is very high risk to be doing general anesthesia or sedation, none of us would want to do it, but apparently many oral surgeons don’t see an issue with it, which seems to beg the question do they really understand the risks of anesthesia and sedation.
 
Eli Manning said:
And by that I mean you have probably never held a scalpel in your hand but maybe 5 times in your career.
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I have used a scalpel on the neck thousands and thousands of times in my career (while placing central lines in the IJ) and I assume many other anesthesiologists have as well.
 
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as an anesthesiologist my most worrisome cases are those with no airway. I can relax and breathe a little if I have an airway. I can tell you with 100% confidence, I would absolutely hate doing and managing sedation all day every day. I'm almost 100% sure I'd find myself talking people out of it. There's just too much risk, unless the patient is still talking/responsive. But people keeping calling moderate sedation that which I am almost sure is general anesthesia with no airway.

Also, we are talking about events that occur maybe 1/1000 or 1/10,000. Or less frequent. So to allude to it never happening to you, or it being perfectly safe for you or for an entire field, just tells me you probably haven't been doing it long enough, or on enough patients. But oral surgery isn't alone in this. I find my partners falling into the same mindset. X, Y, or Z is safe (even though it's not what I would do) because it's what they always do. Well, when we really get into conversation they've done that like 20 times. Or 50. And bad events in anesthesia are rare.

Anyway, just wanted to put that out there.
 
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Southpaw said:
as an anesthesiologist my most worrisome cases are those with no airway. I can relax and breathe a little if I have an airway.
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When they A and B are controlled, the C is much easier to manage. Sedation is all fun and games until things start to go bad and then they go really bad quickly.
 
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Eli Manning said:
wow you took what I said and turned it 180 degrees around. You’re a clown. I never said the situation was laughable or that the slash trach was appropriate. In fact I’m not even commenting on the situation regarding the death of that patient. My comment is directed to you as a person.

I just think it’s absurd that you think an oral surgeon doesn’t know what a scalpel is. And by that I mean you have probably never held a scalpel in your hand but maybe 5 times in your career. Assuming you are actually an attending like your profile says and not an actual clown like you seem.

Does your rubber nose fit behind your mask? Do the surgeon booties fit over your clown shoes?
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Settle down Eli.

My opinion is that any dentist who thinks they can operate and deliver a safe anesthetic simultaneously is the true clown. That includes bozo the clown who think that holding a scalpel makes them somehow fit to rescue an airway 🤡.

You somehow manage to read through an entire thread about the lax safety issues of dentist directed anesthesia, and hone in on a singular comment about dentists holding scalpels. Then you take so much offense to that as to unleash a tirade of attacks. Talk about missing the point entirely. But hey, if you got no substance or rebuttal to any of the other comments on this thread, I suppose that was an outlet for you.
 
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coffeebythelake said:
Settle down Eli.

My opinion is that any dentist who thinks they can operate and deliver a safe anesthetic simultaneously is the true clown. That includes bozo the clown who think that holding a scalpel makes them somehow fit to rescue an airway 🤡.

You somehow manage to read through an entire thread about the lax safety issues of dentist directed anesthesia, and hone in on a singular comment about dentists holding scalpels. Then you take so much offense to that as to unleash a tirade of attacks. Talk about missing the point entirely. But hey, if you got no substance or rebuttal to any of the other comments on this thread, I suppose that was an outlet for you.
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bro that post was almost three months old. Probably should have let that one be bygone.
 
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coffeebythelake said:
So your "evidence" is a post by another poster instead of official lit from a program. Touting nonverifiable statistics. Right....

Re: "but anesthesiologists also have bad outcomes", Scroll up and read my blurb about warped and fatalistic thinking.
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Southpaw said:
as an anesthesiologist my most worrisome cases are those with no airway. I can relax and breathe a little if I have an airway. I can tell you with 100% confidence, I would absolutely hate doing and managing sedation all day every day. I'm almost 100% sure I'd find myself talking people out of it. There's just too much risk, unless the patient is still talking/responsive. But people keeping calling moderate sedation that which I am almost sure is general anesthesia with no airway.

Also, we are talking about events that occur maybe 1/1000 or 1/10,000. Or less frequent. So to allude to it never happening to you, or it being perfectly safe for you or for an entire field, just tells me you probably haven't been doing it long enough, or on enough patients. But oral surgery isn't alone in this. I find my partners falling into the same mindset. X, Y, or Z is safe (even though it's not what I would do) because it's what they always do. Well, when we really get into conversation they've done that like 20 times. Or 50. And bad events in anesthesia are rare.

Anyway, just wanted to put that out there.
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From the ER perspective anesthesia is inherently very dangerous and it always makes me nervous. We do it almost every day for joints, fractures, etc. and it’s true that conscious sedation is often briefly general anesthesia without an airway. We probably over monitor these patients because of our concern but I would rather that than the opposite. We all hear the horror stories of patients sent from outpatient surgical suites.
 
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lucid_leprechaun said:
From the ER perspective anesthesia is inherently very dangerous and it always makes me nervous. We do it almost every day for joints, fractures, etc. and it’s true that conscious sedation is often briefly general anesthesia without an airway. We probably over monitor these patients because of our concern but I would rather that than the opposite. We all hear the horror stories of patients sent from outpatient surgical suites.
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These cases are way scarier than just putting a tube in
 
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lucid_leprechaun said:
From the ER perspective anesthesia is inherently very dangerous and it always makes me nervous. We do it almost every day for joints, fractures, etc. and it’s true that conscious sedation is often briefly general anesthesia without an airway. We probably over monitor these patients because of our concern but I would rather that than the opposite. We all hear the horror stories of patients sent from outpatient surgical suites.
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It ain't conscious sedation when the patient is unconscious. So saying that your conscious sedation procedures is often briefly general anesthesia is disingenuous: you are just fooling yourselves.
 
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coffeebythelake said:
It ain't conscious sedation when the patient is unconscious. So saying that your conscious sedation procedures is often briefly general anesthesia is disingenuous: you are just fooling yourselves.
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Yep. Conscious sedation is versed 1mg, fent 50mcg. Patient is relaxed but still able to have a conversation and follow directions. This is what we do for nerve blocks and cataracts. If you give propofol 30-50 mg, it becomes unconscious sedation.
 
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nimbus said:
Yep. Conscious sedation is versed 1mg, fent 50mcg. Patient is relaxed but still able to have a conversation and follow directions. This is what we do for nerve blocks and cataracts. If you give propofol 30-50 mg, it becomes unconscious sedation.
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We just had our yearly “billing training”. By their definition, or “asa” definition…. During the procedure, if there is “any” period of time, the patient is unconscious, it should be coded as general anesthesia. I’ve always been told colonoscopy with propofol is general anesthesia.
 
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IMGASMD said:
We just had our yearly “billing training”. By their definition, or “asa” definition…. During the procedure, if there is “any” period of time, the patient is unconscious, it should be coded as general anesthesia. I’ve always been told colonoscopy with propofol is general anesthesia.
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why?

you get paid the same rate to sit there and give no drugs as you do to have them under general anesthesia. MAC and GA always bill at the same rate.
 
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Mman said:
why?

you get paid the same rate to sit there and give no drugs as you do to have them under general anesthesia. MAC and GA always bill at the same rate.
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I am not sure why…. Maybe just so everyone is on the same page? Less discrepancy when billing? Or just not having “that” conversation with the surgeon?
 
Mman said:
why?

you get paid the same rate to sit there and give no drugs as you do to have them under general anesthesia. MAC and GA always bill at the same rate.
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Yeah it makes no difference in payment but we should call things what they are. If I give propofol 50mg for a cardioversion, I call it a GA. Same for endo cases with propofol.
 
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Mman said:
why?

you get paid the same rate to sit there and give no drugs as you do to have them under general anesthesia. MAC and GA always bill at the same rate.
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Maybe because some insurance companies won't pay for a MAC on an ASA 1 or 2. I've been told some insurance companies want you to document the reason an anesthesiologist is needed for care on an otherwise healthy patient. So a MAC on an ASA 1 might not pay (from what I've been told).

Call it a general, and it can be an ASA 1 without any issues.

Again, all hearsay, but I've heard of it from multiple people
 
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nimbus said:
Yeah it makes no difference in payment but we should call things what they are. If I give propofol 50mg for a cardioversion, I call it a GA. Same for endo cases with propofol.
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I agree we need to accurately document what we are doing. It just isn't a billing issue. The people paying the reimbursement don't care what you do, just that you are there doing it.
 
OptionOffense said:
If you give propofol 30-50 mg, it becomes general anesthesia
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I mean it kinda depends on the person. I've had people talking to me after 200 mg. I mean not coherently talking, but still babbling on and on.
 
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Mman said:
I mean it kinda depends on the person. I've had people talking to me after 200 mg. I mean not coherently talking, but still babbling on and on.
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ok so after 200 of propofol if they are talking to you, then its conscious sedation
 
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coffeebythelake said:
news.yahoo.com

Changes could be coming to dentist offices across NC after several anesthesia-related deaths

Currently, if a patient needs anesthesia to have a tooth pulled or for oral surgery, a dentist can administer sedation or general anesthesia and perform the procedure at the same time.
news.yahoo.com news.yahoo.com

More tragic stories of dentists killing patients.
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The oral surgeon administered deep sedation to a heart transplant pt???!!! And without any consultation, or preop testing😡
 
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propadope said:
The oral surgeon administered deep sedation to a heart transplant pt???!!! And without any consultation, or preop testing
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Dental Surgeon, DMD: It’s “just” sedation. What are you all yipping about…. I had successfully performed in-tube-bay-tion many many times. My training is consist of watching dental procedures, cleaning teeth, and giving anesthesia, ALL at the SAME time. I already gave one of the jobs, namely put them to sleep to my well trained, ACLS certified dental assistant. This patient is a easy ASA4 patient. You just cannot multitask as well as I can… duh.”
 
propadope said:
The oral surgeon administered deep sedation to a heart transplant pt???!!! And without any consultation, or preop testing😡
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Plenty of arrogant and idiotic dentists out there thinking they know what they are doing. Plenty of them on SDN too. Just look at their spawning grounds on the dental forums.
 
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IMGASMD said:
Dental Surgeon, DMD: It’s “just” sedation. What are you all yipping about…. I had successfully performed in-tube-bay-tion many many times. My training is consist of watching dental procedures, cleaning teeth, and giving anesthesia, ALL at the SAME time. I already gave one of the jobs, namely put them to sleep to my well trained, ACLS certified dental assistant. This patient is a easy ASA4 patient. You just cannot multitask as well as I can… duh.”
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I still remember one of the dentist fools here who thinks that being able to hold a scalpel and cut the neck make him qualified to perform anesthesia. Clown.
 
propadope said:
The oral surgeon administered deep sedation to a heart transplant pt???!!! And without any consultation, or preop testing😡
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Meanwhile I'm over here doing "preops" for dental extractions because they had a stent placed once several years ago and need to know if they need antibiotic prophylaxis ahead of time...because of the stent. Seems there's no real middle ground.
 
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greatnt249 said:
Meanwhile I'm over here doing "preops" for dental extractions because they had a stent placed once several years ago and need to know if they need antibiotic prophylaxis ahead of time...because of the stent. Seems there's no real middle ground.
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The answer is No. To both your comments
 
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IMGASMD said:
I will honestly say, I’ve never done a surgical airway after all my trainings and few years of practice. I don’t planning on doing it either.
@coffeebythelake
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Remember when you were an anesthesia resident 6 months jn? How competent did you think u were in dealing with anesthesia emergencies?
 
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coffeebythelake said:
Remember when you were an anesthesia resident 6 months jn? How competent did you think u were in dealing with anesthesia emergencies?
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After 6+ years, there are still some emergencies and patients I’d rather not deal with. Heart transplant recipient who looked morbidly obese, being one of those.
 
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coffeebythelake said:
Remember when you were an anesthesia resident 6 months jn? How competent did you think u were in dealing with anesthesia emergencies?
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coffeebythelake said:
Remember when you were an anesthesia resident 6 months jn? How competent did you think u were in dealing with anesthesia emergencies?
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But how confident were you that you could competently and safely sedate PS 1 and 2 and select PS 3 patients without incident?
 
Dentists are just so foolish and dumb. Can’t believe they did this !!
 
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