Feel like I need to shed light on this. Complications happen, even with Anesthesiologists. The average oral surgeon will have performed 10’s of thousands of sedations by the time their career is over with no fatalities. I personally have encountered 100’s of Oral Surgeons, none have killed a patient. We do about 8 sedations a day in our clinic. No resident since inception has ever had someone did. Oral and Maxillofacial Surgeons are well trained and spend their entire careers providing moderate sedation on primary healthy ASA 1/2 patients. Patient selection is everything.
There is always variability in programs and rotations and from resident to resident experience. Below is a description of what a general experience is like. Its pretty consistent with most OMFS programs
“5-6 Months General Anesthesia with 1-2 months dedicated to Pediatric Anesthesia.
Main OR
In the main OR you are assisted and taught by the CRNA's/other anesthesia residents the first month, but you do everything. You will learn to start A-Lines, place central lines, etc. They are there to guide you and assist you so you will be ready to run your own rooms for the remaining 4 months.
250+ Intubations and General Anesthetics for all sorts of cases except for transplant/cardiac and OB. Did 10 TIVAS as well.
This included 30+ True blind-awake nasal intubations, 10 blind asleep nasal intubations, a multitude of Fiberoptic intubations, rapid-sequence intubations use of MACS and MILLERS, use of Glydescopes, Lighted Stylets, and Shikani stylets. Wednesdays and Fridays you did the anesthesia for the OMFS cases. The rest of the days were generally for ENT/Plastics/General Surgery/Gyn-Onc/and Ortho. Did a couple regional anesthetic cases and a couple spinals/epidurals just for the experience (but also not really by choice... kinda got stuck there). One of our OMFS faculty was also trained as an Anesthesiologist, so he staffs our GA Cases on wednesdays in the main OR. He's really an airway guru who can teach you a lot. ( He staffs our sedation clinic once a week as well for GA's in the clinic).
Peds Anesthesia Rotation
The peds anesthesia rotation took place in our eye-hospital with high volume cases. Most cases are on healthier kids (more relevant for the OMFS) vs being in the main-or on very sick pedo cases. These kids were there for ENT related things Tonsils/Tubes/Adenoids and Opthalmology things (Exams under anesthesia/eye enucleations/strabismus surgery etc) My youngest intubations were 3-4 months old with average age between 1-4 years of age. Many cases were sevo-mask/open airway ranging anywhere from 5-70 minutes. My log-book numbers here were 20 intubations, 10 LMAs, and 65 pure SEVO-MASK GAs.
After the Pedo's were done for the day we then assisted with the adult cases. I did around 100 IV Sedations/MACs for adults that month as well.
OMFS Clinic and Non Anesthesia Service:
We are very fortunate our main clinic has 3 operatories equipped with 3 GA Machines so 2x/week we still continue our GA skills. We still continue to do IV Sedation as well in that clinic, but they really want us to do GA cases there for continued practice... Some people have even done retro-grade intubations in the clinic. Another OMFS attending of ours also did a 1 year fellowship after residency, so he staffs Pedo cases and GA's as well. The rest of the attendings typically staff IV cases.
In our 2 other clinics where we primarily operate on our attending's private patients the anesthesia experience is more the traditional IV Sedation using Midazolam, Fentanyl, Propofol, Ketamine modalities. Some attendings give you freedom to push drugs on your own, others are very specific with no-freedom as to how/when/what/how-much you give. In those clinics patients are sedated almost every day in a private practice fashion... multiple cases throughout the day.
The ER
Senior OMFS are also called to the ER to do Pedi-Sedations under the "er attending supervision" for our OMFS related ER consults if needed. These are typically Glyco-Midaz-Ketamine darts for quick procedures in the ER. Hardest part here is dealing with the NPO status or dealing with newer attendings not as comfortable with these situations.
Personally, I feel pretty well trained from this experience, but this is one area that you cannot get slack on. No matter what you have to keep learning and keep practicing. Most people won't intubate when they go their private offices, but they should still take the opportunity in the OR to intubate and keep those skills fresh.
This is probably one of the most important services we as OMFS can provide to the public and the dental community, but its also one of the ways that we can have negative effects too. We have a great safety track-record historically with death/adverse complication approaching 1 in 750,000 to 1,000,000 anesthetics administered by OMFS. Lets not only keep it that way, lets strive to improve it and continue to be the envy of our counterparts.”
