Office anesthesia/IV sedation for wisdom teeth...continued.
In a previous blog, current advances in evaluation and treatment of patients needing in office sedation was discussed. Many patients needing oral surgery or dental implant placement need or request IV sedation for a variety of reasons. Anxiety regarding the procedure, as well as the fact that many of these procedures are impossible to perform comfortably with local anesthesia alone, are indications for sedation.
Increasingly, nonspecialist dentists have been promoting use of sedation in the office for dental or oral surgical procedures. The public must be assured that the care in the dental office has the same level of safety as an anesthetic provided in a hospital or accredited ambulatory surgery center. Since the 1970's, members of the American Association of Oral and Maxillofacial Surgeons (AAOMS) have used the Office Anesthesia Evaluation (OAE) as a way of certifying that the standards established for anesthesia care are met. AAOMS members in the state of Michigan undergo the OAE every 5 years. Unfortunately, the state has no similar organized mechanism to evaluate non-oral surgeon dentists and their offices in the same manner.
Anesthesia standard of care changes were a main topic of the Anesthesia symposia at the recent AAOMS annual meeting and scientific session in Philadelphia last month. Some of the changes in office surgery have to do with changes mandated by the federal government through the Centers of Medicare/Medicaid Services (CMS). The Joint Commission, which is responsible for accrediting hospitals and healthcare centers, uses CMS critera in it's evaluation of healthcare providers. CMS and now the Joint Commission are placing restrictions on the practice of operator anesthetists in the hospital setting. Examples of this practice would be a physician administering an intravenous sedative as part of an endoscopic exam or minor surgical procedure. Oral surgeons are also classified as operator anesthetists however, they provide the service generally outside of the hospital setting and are currently not regulated in this way.
CMS has also promulgated new rules on monitoring of the patient during IV sedation or general anesthesia. End tidal capnography (exhaled CO2 monitoring) is now required for the assessment of ventilation of patients during IV sedation and general anesthesia. A time oriented anesthesia record is also part of the newly evolving standard as well. While oral surgeons are not directly regulated by CMS or the Joint Commission, the general consensus is that these elements of anesthesia monitoring will soon be the standard of care in dental/oral surgery offices as well. In our office we have been using end tidal capnography for over three years, and feel it is valuable in assessing patient ventilation during IV sedation.
Preoperative evaluation of patients was also a topic of interest at the annual meeting. The recent increase in the prevalence of younger overweight and obese patients requires a reassessment of risk for IV sedation in the office. Overweight and obesity have been positively linked to undiagnosed cardiovascular diseases as well as diabetes and pulmonary difficulties. The significantly overweight or obese patient has an increased risk of having sleep apnea which can increase the risk of anesthetic complications. Proper preanesthetic assessment for these conditions will allow a modification of the type of anesthetic available to the patient or, the option for anesthesia care by an anesthesiologist in a hospital setting if indicated.
If you wish to learn more about IV sedation options available in our office for a procedure call to schedule a consultation with one of our board certified oral & maxillofacial surgeons.
