What does this mean for OMFS?

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DREDAY

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Anyone know what this means for OMFS? Will this impact us? Can we continue to perform our procedures and sedation at same time?


FDA Upholds ASA Stance on Safe Use of Propofol
Thursday, August 19, 2010

In 2005, ASA submitted comments to and testified before the FDA opposing a Citizen Petition (Docket FDA-2005-P-0059) by the American College of Gastroenterology (ACG) asking that FDA remove the following language:

“For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectible Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.”

In a letter dated August 11, 2010, and made available on August 16, FDA denied the ACG petition in its entirety.

FDA summarized its reasoning as follows (page 2): "After considering your [petitioners'] claims and the literature you provided for our review, we conclude that you have not shown that the warning is no longer warranted or appropriate. In fact, we conclude that the warning is warranted and appropriate in light of the significant risks associated with propofol, and we further conclude that the warning should help ensure that propofol is used safely. Accordingly, we will not seek to have the warning removed, reduced, or otherwise amended."

The letter also references ASA, saying that the warning is consistent with recommendations of ASA, among others (see p. 7, p. 11, footnote 20). FDA also dispatched ACG's cost contention, saying that added costs associated with having an anesthesiologist administer the drug was warranted in light of the risks.

Finally, FDA concluded that the warning did not unduly restrict the practice of gastroenterology, mentioning that hospitals typically set their own procedures, but that in any event the warning was "appropriate and warranted in light of the significant risks associated with propofol."
 
Whatever, then I'll use more brevital or pentothal. Our clinic is doing just fine with brevital since the propofol shortage.
 
We are currently doing a study which will prove the safety and efficacy of propofol in the outpatient OMF setting at our institution. We will have a huge sample size and it is being co-authored by a PHD pharm who has authored tons of literature out there.

It will provide unequivocal evidence....stay tuned
 
It means nothing, the ASA has never intended to include OMS in this restriction of use of propofol, see letter below from ASA president in 2004. A copy of this letter comes in handy when anesthesia doesn't want to give you the "privledge" of using propofol outside of the OR if you are hospital based. see link below.
 

Attachments

It means nothing, the ASA has never intended to include OMS in this restriction of use of propofol, see letter below from ASA president in 2004. A copy of this letter comes in handy when anesthesia doesn't want to give you the "privledge" of using propofol outside of the OR if you are hospital based. see link below.

Beautiful. Hopefully this sentiment will persist.
 
The more we oral surgeons try to 'refine' our practices methods the more we seem to paint a target on our backs...really I'd say the majority of oral surgeons take no longer than 20-30 min start to finish for set of 4 wizzies, 20% of that is 6mins...big deal, we have the best ambulatory GA record comparitive to ANY field..yet we try to mess with a good thing.

Maybe I'm getting pre-grad jitters, think I'll be starvin in private practice (mostly because I am right now), but it seems like the old F--kers are just messing it up for us guys up and coming. Not everyone wants to do double jaws in an office yah know...and believe me the ultimate end point of this is for OS to put themselves in a position to open said Surgery centers, hire anesthesiologists to run outpt GA and do their own cases free from scrutiny of community hospitals. F--k that, gimmie my T&T...a--hats.

I may be the only one saying it, but deep deep down ALOT of soon to be OMFS have these same thoughts...lets protect our turf guys.. These are the same clowns pushing for OMFS match straight from med school as an alternate path to oral sx. Consider this, the more MD's we have, the more ppl seeking out these MD's (for whatever reason, since, in no way does it make you a better surgeon on average, c'mon yr 3 and 4 of med school, everyone here knows those yrs are jokes, gimmie a break), the more the medical community and AMA feel they have a say in our scope, but everyone keeps ignoring it, sh-t we seem to be embracing it.
 
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The more we oral surgeons try to 'refine' our practices methods the more we seem to paint a target on our backs...really I'd say the majority of oral surgeons take no longer than 20-30 min start to finish for set of 4 wizzies, 20% of that is 6mins...big deal, we have the best ambulatory GA record comparitive to ANY field..yet we try to mess with a good thing.

Maybe I'm getting pre-grad jitters, think I'll be starvin in private practice (mostly because I am right now), but it seems like the old F--kers are just messing it up for us guys up and coming. Not everyone wants to do double jaws in an office yah know...and believe me the ultimate end point of this is for OS to put themselves in a position to open said Surgery centers, hire anesthesiologists to run outpt GA and do their own cases free from scrutiny of community hospitals. F--k that, gimmie my T&T...a--hats.

I may be the only one saying it, but deep deep down ALOT of soon to be OMFS have these same thoughts...lets protect our turf guys.. These are the same clowns pushing for OMFS match straight from med school as an alternate path to oral sx. Consider this, the more MD's we have, the more ppl seeking out these MD's (for whatever reason, since, in no way does it make you a better surgeon on average, c'mon yr 3 and 4 of med school, everyone here knows those yrs are jokes, gimmie a break), the more the medical community and AMA feel they have a say in our scope, but everyone keeps ignoring it, sh-t we seem to be embracing it.


Goro,

I'm not judging. And there is nothing wrong with T and T but I have a question. Why did you waste 4 years doing OMF when you could have done a good AEGD/GPR and been able to take out wizzies and fire in implants in nice cases?

I mean, to combat the scope issue- your argument seems pretty bassackwards to me, lets protect our scope by getting less training/credentials? Hmmmm.... I don't get it.

(AND I'm NOT arguing 4 vs. 6- I know there is no difference wrt the surgical skill set! It is based on training)

Anyhow, good luck on your boards and stuff dude- when all is said and done and you're in practice, keep posting on here. I want to hear how you find practice and if your thoughts have changed....
 
Goro,

I'm not judging. And there is nothing wrong with T and T but I have a question. Why did you waste 4 years doing OMF when you could have done a good AEGD/GPR and been able to take out wizzies and fire in implants in nice cases?

I mean, to combat the scope issue- your argument seems pretty bassackwards to me, lets protect our scope by getting less training/credentials? Hmmmm.... I don't get it.

(AND I'm NOT arguing 4 vs. 6- I know there is no difference wrt the surgical skill set! It is based on training)

Anyhow, good luck on your boards and stuff dude- when all is said and done and you're in practice, keep posting on here. I want to hear how you find practice and if your thoughts have changed....

Not a waste..I love surgery, I love what I do. Nothing else in dentistry comes close to the experiences we get. period.


Trauma is my joy, gnathics, and path are icing on the cake. But T&T pays the bills. The origination of this thread is based on T&T associated procedures, that is what I was addressing. Why change something that is working fine? Why add another element?

My speculation is that we as a profession, by the roots planted by a few, are slowly 'giving up' what got a lot of us started in DS, what a lot of us ALSO enjoy addition to 'real' surgery and what will help pay my 200K loan off.

Nobody said anything about limiting scope, not sure where that came from; unless you're equate getting an MD to expanding scope, then my friend you have joined the line of ppl that think the only way we can expand what we do is by getting a nod from our medical couterparts. We don't need it. By that psychology, why go be a OMFS in the first place? go do ENT, or plastics, surg onc?

My original statement stands; the more we invite the MD's, like it or not the more we give them a say in what we do.

Good luck on your boards as well, but a word of advice, don't say 'not judging' then go on to judge. You must have known there was another unstated side to the argument. It makes you seem like a prick. And for all I know you may be a nice guy, but none the less, like a prick is how these people come off in real life.

I was back up last night, had a rough night...sleep time peace out..
 
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