2 Sedation Deaths in Arizona: One Periodontist and One GP both using same CRNA

[DavesNotHere]

Very tragic stuff. It's a harsh reality that sedating people in a dental office is a lot harder than sedating them in a hospital. If you're a GP or a Periodontist or a Pedodontist you should not be hiring anyone other than a Dental Anesthesiologist or a physician Anesthesiologist with specific outpatient training to sedate in your office. This GP and Periodontist cut that corner and their patients paid the ultimate price.

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

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[AfterEffects]

Very sad indeed. At quick glance through the article, the dentist had no sedation permit/credentials at all? Sounds like a recipe for disaster. It appears the periodontists had their paperwork in order. Airway fires are very scary. Still pretty crazy they can offer "general anesthesia" in their office without actually being trained to provide general anesthesia themselves. Although with more states allowing independent practice of CRNAs, I'm sure this only going to occur more often.

 

[Pennywisdom]

Angela Fountain (Nursing Board Member): "Job well done."

Okay "doctor".

 

[somefuturedoc]

2 patients dead, and the nursing board finds nothing wrong with his work and even says well done

Hmmm

 

[ThirdMolarz]

"These were two very unique cases, performed by oral surgeons (not “dentists”) with tragic outcomes," says the nurse anesthetist's lawyer. Can we fact check that? Don't think oral surgeons were involved

 

[D1Bound]

Very tragic stuff. It's a harsh reality that sedating people in a dental office is a lot harder than sedating them in a hospital. If you're a GP or a Periodontist or a Pedodontist you should not be hiring anyone other than a Dental Anesthesiologist or a physician Anesthesiologist with specific outpatient training to sedate in your office. This GP and Periodontist cut that corner and their patients paid the ultimate price.

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

Or an oral surgeon?

 

[2TH MVR]

Condolences to the patients and their families. Very sad to hear.
I know the owners of AZ Perio. They are a 1st class outfit. Shocked to hear that they would use a NA for sedation. Why not use a true dental anesthesiologist?

 

[deleted1047421]

Very tragic stuff. It's a harsh reality that sedating people in a dental office is a lot harder than sedating them in a hospital. If you're a GP or a Periodontist or a Pedodontist you should not be hiring anyone other than a Dental Anesthesiologist or a physician Anesthesiologist with specific outpatient training to sedate in your office. This GP and Periodontist cut that corner and their patients paid the ultimate price.

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

Anesthesia complications can happen anywhere, anytime.

It’s important to practice anesthesia with caution and maintain a humble attitude.

CRNAs in general are very well trained anesthetists. In fact I know of two oral surgeons who actually use them in daily practice.
One bad apple shouldn’t be used to generalize an entire group of otherwise skilled providers.

I honestly don’t see the difference between hiring a crna or dental anesthesiologist. To my understanding their anesthesia training is quite similar. Both are in intensive programs for roughly two years.

An MD anesthesiologist is different. They have a far more extensive training. But even then they have complications in dental offices as well, that you can find on Google. No one is immune to anesthesia complications.

 

[Onyxxx7]

Anesthesia complications can happen anywhere, anytime.

It’s important to practice anesthesia with caution and maintain a humble attitude.

CRNAs in general are very well trained anesthetists. In fact I know of two oral surgeons who actually use them in daily practice.
One bad apple shouldn’t be used to generalize an entire group of otherwise skilled providers.

I honestly don’t see the difference between hiring a crna or dental anesthesiologist. To my understanding their anesthesia training is quite similar. Both are in intensive programs for roughly two years.

An MD anesthesiologist is different. They have a far more extensive training. But even then they have complications in dental offices as well, that you can find on Google. No one is immune to anesthesia complications.

It’s three years for both CRNA and DA. Medical anesthesia is 3 + 1 (intern year).

 

[DavesNotHere]

Anesthesia complications can happen anywhere, anytime.

It’s important to practice anesthesia with caution and maintain a humble attitude.

CRNAs in general are very well trained anesthetists. In fact I know of two oral surgeons who actually use them in daily practice.
One bad apple shouldn’t be used to generalize an entire group of otherwise skilled providers.

I honestly don’t see the difference between hiring a crna or dental anesthesiologist. To my understanding their anesthesia training is quite similar. Both are in intensive programs for roughly two years.

An MD anesthesiologist is different. They have a far more extensive training. But even then they have complications in dental offices as well, that you can find on Google. No one is immune to anesthesia complications.

I think your understanding of their training is really lacking then. CRNAs get just about zero outpatient training. Nearly zero dental cases. Dental anesthesia’s whole focus is to prepare them to provide outpatient anesthesia for dentists. CRNAs don’t get any of that.

Why don’t you google all the outpatient deaths that have occurred with dental anesthesiologists.

And OMFS can safely hire them because OMFS are also experts in outpatient anesthesia.

 

[DavesNotHere]

It’s three years for both CRNA and DA. Medical anesthesia is 3 + 1 (intern year).

Most CRNA programs do only a year of clinical anesthesia and only an extremely small percentage of that is outpatient.

 

[DavesNotHere]

Or an oral surgeon?

Why would a dentist hire an oral surgeon to do GA in their office?

 

[Sublimazing]

Anesthesia complications can happen anywhere, anytime.

It’s important to practice anesthesia with caution and maintain a humble attitude.

CRNAs in general are very well trained anesthetists. In fact I know of two oral surgeons who actually use them in daily practice.
One bad apple shouldn’t be used to generalize an entire group of otherwise skilled providers.

I honestly don’t see the difference between hiring a crna or dental anesthesiologist. To my understanding their anesthesia training is quite similar. Both are in intensive programs for roughly two years.

An MD anesthesiologist is different. They have a far more extensive training. But even then they have complications in dental offices as well, that you can find on Google. No one is immune to anesthesia complications.

Yeah i agree it sounds like you’re not familiar with dental anesthesiology really at all.

The programs are 3 years of clinical experience after a doctorate in the field you’ll be doing anesthetics on. CRNAs are nurses who do 1-2 years of academics before even seeing propofol.

When i graduated i had done 1200 nasal intubations…no CRNA on the planet has ever graduated with 10% of that. I did 800 outpatient sedations for dentists…and that was when the program was only 2 years.

I personally bring in a CRNA a couple times a month just because some cases require a separate anesthetist, but i could run laps around this guy academically and clinically when it comes to sedating people in a dental office.

I think a CRNA can become good at providing outpatient sedation with years of experience…but to say the training is the same is objectively wrong.

 

[deleted1047421]

I think your understanding of their training is really lacking then. CRNAs get just about zero outpatient training. Nearly zero dental cases. Dental anesthesia’s whole focus is to prepare them to provide outpatient anesthesia for dentists. CRNAs don’t get any of that.

Why don’t you google all the outpatient deaths that have occurred with dental anesthesiologists.

And OMFS can safely hire them because OMFS are also experts in outpatient anesthesi

Yeah i agree it sounds like you’re not familiar with dental anesthesiology really at all.

The programs are 3 years of clinical experience after a doctorate in the field you’ll be doing anesthetics on. CRNAs are nurses who do 1-2 years of academics before even seeing propofol.

When i graduated i had done 1200 nasal intubations…no CRNA on the planet has ever graduated with 10% of that. I did 800 outpatient sedations for dentists…and that was when the program was only 2 years.

I personally bring in a CRNA a couple times a month just because some cases require a separate anesthetist, but i could run laps around this guy academically and clinically when it comes to sedating people in a dental office.

I think a CRNA can become good at providing outpatient sedation with years of experience…but to say the training is the same is objectively wrong

Yeah i agree it sounds like you’re not familiar with dental anesthesiology really at all.

The programs are 3 years of clinical experience after a doctorate in the field you’ll be doing anesthetics on. CRNAs are nurses who do 1-2 years of academics before even seeing propofol.

When i graduated i had done 1200 nasal intubations…no CRNA on the planet has ever graduated with 10% of that. I did 800 outpatient sedations for dentists…and that was when the program was only 2 years.

I personally bring in a CRNA a couple times a month just because some cases require a separate anesthetist, but i could run laps around this guy academically and clinically when it comes to sedating people in a dental office.

I think a CRNA can become good at providing outpatient sedation with years of experience…but to say the training is the same is objectively wrong.

Yeah i agree it sounds like you’re not familiar with dental anesthesiology really at all.

The programs are 3 years of clinical experience after a doctorate in the field you’ll be doing anesthetics on. CRNAs are nurses who do 1-2 years of academics before even seeing propofol.

When i graduated i had done 1200 nasal intubations…no CRNA on the planet has ever graduated with 10% of that. I did 800 outpatient sedations for dentists…and that was when the program was only 2 years.

I personally bring in a CRNA a couple times a month just because some cases require a separate anesthetist, but i could run laps around this guy academically and clinically when it comes to sedating people in a dental office.

I think a CRNA can become good at providing outpatient sedation with years of experience…but to say the training is the same is objectively wrong.

Thanks for posting about the differences in training.

I have worked with CRNAs in the past and the ones that I’ve encountered have been good. Admittedly I don’t use them for outpatient procedures. I do all my own anesthesia, in office.

My colleagues claim that the ones they use are pretty good and experienced, and they use them for outpatient anesthesia. They’ve used them for years on a daily basis.

The point I was originally trying to make was not really to compare DAs to CRNAs or their training. Anesthesia complications can happen anywhere, anytime. Adverse anesthesia outcomes can happen even to the most experienced providers and the best setup.

 

[D1Bound]

Why would a dentist hire an oral surgeon to do GA in their office?

Do oral surgeons ever do solo anesthesia if they can't do surgery anymore? I'm asking I don't know

 

[Eli Manning]

The GP that hired the CRNA had no anesthesia training and had no permit to perform anesthesia in their office. IMO that dentist should have their license revoked and never touch another patient again.

I found this online while googling the incident.

https://dentalboard.az.gov/sites/default/files/6-12-2020%20FINAL%20MINUTES.pdf

This statement cracks me up “The Board stated that Dr. Pourshirazi is essentially agreeing to not do something that he already cannot do since he does not hold any type of anesthesia or sedation permit.”

Its people like this that think they are above the law/rules and give our profession a bad name.

 

[D1Bound]

The GP that hired the CRNA had no anesthesia training and had no permit to perform anesthesia in their office. IMO that dentist should have their license revoked and never touch another patient again.

I found this online while googling the incident.

https://dentalboard.az.gov/sites/default/files/6-12-2020%20FINAL%20MINUTES.pdf

This statement cracks me up “The Board stated that Dr. Pourshirazi is essentially agreeing to not do something that he already cannot do since he does not hold any type of anesthesia or sedation permit.”

Its people like this that think they are above the law/rules and give our profession a bad name.

Why is a hygienist the president of a dental examiner board?

 

[LegendaryPanda]

Thanks for posting about the differences in training.

I have worked with CRNAs in the past and the ones that I’ve encountered have been good. Admittedly I don’t use them for outpatient procedures. I do all my own anesthesia, in office.

My colleagues claim that the ones they use are pretty good and experienced, and they use them for outpatient anesthesia. They’ve used them for years on a daily basis.

The point I was originally trying to make was not really to compare DAs to CRNAs or their training. Anesthesia complications can happen anywhere, anytime. Adverse anesthesia outcomes can happen even to the most experienced providers and the best setup.

The difference isn't just knowing how to provide anesthesia, which MA's and DA's would definitely have an edge on, but also knowing how to manage the complications when they arise. IIRC, CRNA's have 2 to 3.5 years of education after their nursing degree, which consists of both their anesthesia training and didactic courses combined. I respect nurses, but there's no way they're learning the totality of what med or dental students learn in dental school in those 3 years, let alone combined with residency. I am sure CRNA's know how to administer anesthesia, the difference will surely shine when something out of the norm happens.

 

[deleted1047421]

The difference isn't just knowing how to provide anesthesia, which MA's and DA's would definitely have an edge on, but also knowing how to manage the complications when they arise. IIRC, CRNA's have 2 to 3.5 years of education after their nursing degree, which consists of both their anesthesia training and didactic courses combined. I respect nurses, but there's no way they're learning the totality of what med or dental students learn in dental school in those 3 years, let alone combined with residency. I am sure CRNA's know how to administer anesthesia, the difference will surely shine when something out of the norm happens.

you have an excellent contribution.

Again my original point is that anesthesia complications happen. They happen to anesthesiologists and all other providers that administer anesthesia. Even those well trained to manage complications can still face them and have an adverse outcome. It’s unfortunate but that is the reality. Thankfully those are quite rare.

 

[Contach]

I think your understanding of their training is really lacking then. CRNAs get just about zero outpatient training. Nearly zero dental cases. Dental anesthesia’s whole focus is to prepare them to provide outpatient anesthesia for dentists. CRNAs don’t get any of that.

Why don’t you google all the outpatient deaths that have occurred with dental anesthesiologists.

And OMFS can safely hire them because OMFS are also experts in outpatient anesthesia.

I am only familar with 2 DA programs (I think there are less than 10 in the country?) and they both spend the majority (more than 75%) of their time covering OR cases. ie: general anesthesia intubated cases in the hospital. Doesn't jive with what they end up doing when they come out of residency. But it does fill the labor need of the hospitals that have these programs.

 

[Contach]

The difference isn't just knowing how to provide anesthesia, which MA's and DA's would definitely have an edge on, but also knowing how to manage the complications when they arise. IIRC, CRNA's have 2 to 3.5 years of education after their nursing degree, which consists of both their anesthesia training and didactic courses combined. I respect nurses, but there's no way they're learning the totality of what med or dental students learn in dental school in those 3 years, let alone combined with residency. I am sure CRNA's know how to administer anesthesia, the difference will surely shine when something out of the norm happens.

Dental students don't learn **** about anesthesia (beyond local anesthesia). Let's be real.
I feel an average RN knows more about sedation and anesthesia than a general dentist.

All the training that a DA will have about anesthesia will be from DA residency. Likewise if you are a CRNA. CRNAs have to become an RN, then work a couple years in the ICU or a similar higher level of care setting, then go back to school for CRNA school.

 

[Contach]

Do oral surgeons ever do solo anesthesia if they can't do surgery anymore? I'm asking I don't know

Why wouldn't they be able to do surgery? If they are not medically fit to do surgery, then they are likely not medically fit for anesthesia.
I've never heard of this. The OMS I've met, who can't do surgery anymore will go into teaching: dental schools, or residencies where the toll on the body is less.

 

[Sublimazing]

I am only familar with 2 DA programs (I think there are less than 10 in the country?) and they both spend the majority (more than 75%) of their time covering OR cases. ie: general anesthesia intubated cases in the hospital. Doesn't jive with what they end up doing when they come out of residency. But it does fill the labor need of the hospitals that have these programs.

Mine wasn’t like that. 12 months of it was in the surgery center within the dental school and was the majority of our cases. The NY programs (back in 2011-14) were very hospital heavy but UCLA, Loma Linda, and Pitt did a lot of outpatient dental anesthesia.

I don’t know what the landscape looks like now.

 

[Rambunctious]

The mouth fire incident is just crazy bad luck. When do you ever hear about that happening and someone dying on top of that. The first case without having a sedation permit and not calling 911 fast enough because of that is psychotic. I feel like that nurse took all the heat but that dentist really messed up.

 

[Sublimazing]

The mouth fire incident is just crazy bad luck. When do you ever hear about that happening and someone dying on top of that. The first case without having a sedation permit and not calling 911 fast enough because of that is psychotic. I feel like that nurse took all the heat but that dentist really messed up.

Airway fires aren’t that uncommon. There are 500 - 750 airway fires per year in the hospital setting. You don’t see them as much outpatient because you don’t see a lot of laser usage during open airway sedation…and the people that do are smart enough to turn down the O2.

But if you’ve spent anytime in the OR you know every timeout includes a fire risk, and non-intubated airway is very high.

I’ve known 2 DAs who had airway fires (neither fatal). I just started using Stryker’s new titanium/nylon cutting guides on our leforts, and when the sonopet hits them it sparks like an autoshop. Even with the patient tubed I tell them to turn the O2 as low as possible.

 

[Rambunctious]

Airway fires aren’t that uncommon. There are 500 - 750 airway fires per year in the hospital setting. You don’t see them as much outpatient because you don’t see a lot of laser usage during open airway sedation…and the people that do are smart enough to turn down the O2.

But if you’ve spent anytime in the OR you know every timeout includes a fire risk, and non-intubated airway is very high.

I’ve known 2 DAs who had airway fires (neither fatal). I just started using Stryker’s new titanium/nylon cutting guides on our leforts, and when the sonopet hits them it sparks like an autoshop. Even with the patient tubed I tell them to turn the O2 as low as possible.

Damn that's insane! I'm happy doing bread and butter dentistry. No fires here, yet.

 

[Sublimazing]

Damn that's insane! I'm happy doing bread and butter dentistry. No fires here, yet.

You should consider adding some pyrotechnics to your normal routine. The patient’s love a good show.

 

[dentist1975]

The GP that hired the CRNA had no anesthesia training and had no permit to perform anesthesia in their office. IMO that dentist should have their license revoked and never touch another patient again.

I found this online while googling the incident.

https://dentalboard.az.gov/sites/default/files/6-12-2020%20FINAL%20MINUTES.pdf

This statement cracks me up “The Board stated that Dr. Pourshirazi is essentially agreeing to not do something that he already cannot do since he does not hold any type of anesthesia or sedation permit.”

Its people like this that think they are above the law/rules and give our profession a bad name.

Why can’t a GP hire a DA or CRNA? Isn’t that th whole purpose of bringing in an anesthesiologist?

 

[tinman831]

Why can’t a GP hire a DA or CRNA? Isn’t that th whole purpose of bringing in an anesthesiologist?

Some states require CRNA's to work under the supervision of someone certified to provide those sedation services, such as an MD or OMFS. Also there are fairly strict permitting requirements that must be met in order to provide these types of sedation in the office.

 

[DocMon16]

Why can’t a GP hire a DA or CRNA? Isn’t that th whole purpose of bringing in an anesthesiologist?

They can hire a DA because they are a licensed provider that can perform GA and don't need supervision. CRNA's typically need to be supervised by MD or OMFS but this may also be based on what state they are practicing in. CRNA's can be supervised by a dentist that doesn't have proper anesthesia licensing or permits.

 

[Eli Manning]

Airway fires aren’t that uncommon. There are 500 - 750 airway fires per year in the hospital setting. You don’t see them as much outpatient because you don’t see a lot of laser usage during open airway sedation…and the people that do are smart enough to turn down the O2.

But if you’ve spent anytime in the OR you know every timeout includes a fire risk, and non-intubated airway is very high.

I’ve known 2 DAs who had airway fires (neither fatal). I just started using Stryker’s new titanium/nylon cutting guides on our leforts, and when the sonopet hits them it sparks like an autoshop. Even with the patient tubed I tell them to turn the O2 as low as possible.

You use a Sonopet to do orthognathic? ... WHY !?


Also I agree with Contach, dental students dont learn **** about anesthesia or managing medical emergencies. A dentist is no more prepared to handle an anesthetic complication than the local manager at Arby's. That is why it is always questionable when you see a general dentist doing IV sedation in their office.

 

[Sublimazing]

You use a Sonopet to do orthognathic? ... WHY !?


Also I agree with Contach, dental students dont learn **** about anesthesia or managing medical emergencies. A dentist is no more prepared to handle an anesthetic complication than the local manager at Arby's. That is why it is always questionable when you see a general dentist doing IV sedation in their office.

Why wouldn’t you? I saw the best surgeon i’ll ever know transect a nerve once with the recip saw. Never have to worry about thar again. Inferior border cut is completely safe. I take it through the cortex so most of the time I don’t even need a chisel to split the sag.

I can assure you that cutting an osteotomy did not reach its surgical perfection in 1968.

 

[Eli Manning]

Why wouldn’t you? I saw the best surgeon i’ll ever know transect a nerve once with the recip saw. Never have to worry about thar again. Inferior border cut is completely safe. I take it through the cortex so most of the time I don’t even need a chisel to split the sag.

I can assure you that cutting an osteotomy did not reach its surgical perfection in 1968.

are you trying to suggest that surgical procedures improve over time ?!

I'm just being a troll, I think the sonopet is a great use for orthognathic

 

[AONLINE]

Do most periodontists receive adequate training to perform conscious sedation?

 

[deleted1082923]

Do most periodontists receive adequate training to perform conscious sedation?

Usually not.