Sunday Night with Megyn Kelly: "Children at Risk? Kids and Sedation at the Dentist’s Office"

[Carbocation1]

Children at Risk? Kids and Sedation at the Dentist’s Office
SUN, JUL 09

"After a string of recent deaths, NBC News’ Kate Snow explores the risks associated with sedation in dental offices. A growing chorus of advocates including pediatricians and lawmakers are calling for change."

Children at Risk? Kids and Sedation at the Dentist’s Office

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[anbuitachi]

"broke all his teeth", wow.
The whole not for money is complete bullcrap. How about change it so they can't bill for the anesthesia and see how likely they are to do it vs having an anesthesiologist.
The whole no evidence crap is also bullcrap. THey dont even keep records of their morbidity/mortality. Of course they have no evidence. No evidence doesn't mean its' the right thing to do.

Their reasoning that they should continue, because its always been done this way is also dumb. Surgeons was in charge of the anesthesia back in the very old days. But just cause it was done back then doesn't mean we should do it now
The ASA should get on top of this and advocate for the bill to pass.

According to the OMFS website, "As a result of their extensive training, every Oral and Maxillofacial Surgeon is well-prepared to appropriately administer local anesthesia, all forms of sedation and general anesthesia. " . I guess their training in their residency is equivalent to our residency training =\

 

[anbuitachi]

Why are kids dying at the dentist?

This site has more info.. its sad how some greedy dentists/omfs are willing to harm their patients for their own gains.

 

[Noyac]

I do site visits for a local dentist/OMF office for sedation credentials. He doesn't do Ped's or else I wouldn't be involved. But he is extremely eager to meet all requirements and to learn more up to date forms of monitoring and uses of medications. But all of this is expensive. We run through all kinds of emergency drills and they (he and his team) are very good at protocol. But they can't think very well outside of the box or if things don't go as expected. It's scary.

 

[GA8314]

"broke all his teeth", wow.
The whole not for money is complete bullcrap. How about change it so they can't bill for the anesthesia and see how likely they are to do it vs having an anesthesiologist.
The whole no evidence crap is also bullcrap. THey dont even keep records of their morbidity/mortality. Of course they have no evidence. No evidence doesn't mean its' the right thing to do.

Their reasoning that they should continue, because its always been done this way is also dumb. Surgeons was in charge of the anesthesia back in the very old days. But just cause it was done back then doesn't mean we should do it now
The ASA should get on top of this and advocate for the bill to pass.

According to the OMFS website, "As a result of their extensive training, every Oral and Maxillofacial Surgeon is well-prepared to appropriately administer local anesthesia, all forms of sedation and general anesthesia. " . I guess their training in their residency is equivalent to our residency training =\

The OMFS guys where I trained were unbelievably arrogant about their "extensive" anesthesia skills. It was unreal. Totally dangerous in their attitude towards anesthesia. Granted, we did the anesthesia on those cases, but who knows what they were doing outpatient.

 

[pgg]

The OMFS residents rotate with us for 6 months. They spend some time in the SICU too, and they generally do well. They're smart people. It's a tough selection process to get into their program. They work hard, and on the whole they leave us with anesthesia skills and knowledge roughly comparable to a 6-month CA-1, which I think is impressive as hell for guys who didn't go to medical school.

But show of hands, who would send a January CA-1 off to the dental clinic to provide a general anesthetic to anyone?

Our OMFS dept has a full setup including anesthesia machines in their outpatient clinic, but I think the vast majority of the anesthesia they do is sedation. They book cases requiring GA for the main OR and we do the anesthesia for them, so I don't think they're really pushing the envelope in their clinic. Even though they're credentialed to do so.

Makes me a little anxious to think of what other OMFS'ers are doing out there, but you can't worry about everything. They've got their own licensing and credentialing process; not our place or the ASA's to tell them what they should and shouldn't do.

 

[anbuitachi]

The OMFS residents rotate with us for 6 months. They spend some time in the SICU too, and they generally do well. They're smart people. It's a tough selection process to get into their program. They work hard, and on the whole they leave us with anesthesia skills and knowledge roughly comparable to a 6-month CA-1, which I think is impressive as hell for guys who didn't go to medical school.

But show of hands, who would send a January CA-1 off to the dental clinic to provide a general anesthetic to anyone?

Our OMFS dept has a full setup including anesthesia machines in their outpatient clinic, but I think the vast majority of the anesthesia they do is sedation. They book cases requiring GA for the main OR and we do the anesthesia for them, so I don't think they're really pushing the envelope in their clinic. Even though they're credentialed to do so.

Makes me a little anxious to think of what other OMFS'ers are doing out there, but you can't worry about everything. They've got their own licensing and credentialing process; not our place or the ASA's to tell them what they should and shouldn't do.

OMFS does go to med school i thought. Dont they have to do the clinical 2 years (MS3/4?) . Wait you aren't comfortable with a Jan CA1 providing anesthesia to your 4 yr old while doing surgery?? Weird

 

[WholeLottaGame7]

Sad every time. Hell, I didn't know how dangerous it was taking care of kids until I did anesthesia residency, and didn't get really scared until doing a peds fellowship; you can't really expect parents to know enough to be afraid. Maybe enough high-profile cases happen and that would change.

 

[Noyac]

Sad every time. Hell, I didn't know how dangerous it was taking care of kids until I did anesthesia residency, and didn't get really scared until doing a peds fellowship; you can't really expect parents to know enough to be afraid. Maybe enough high-profile cases happen and that would change.

Pedi anesthesia isn't scary until you are well trained.

 

[anbuitachi]

Sad every time. Hell, I didn't know how dangerous it was taking care of kids until I did anesthesia residency, and didn't get really scared until doing a peds fellowship; you can't really expect parents to know enough to be afraid. Maybe enough high-profile cases happen and that would change.

I mean in peds fellowship you do a lot sicker patients im guessing. Lots of peds hearts, peds liver transplants etc?

 

[twoliter]

OMFS does go to med school i thought. Dont they have to do the clinical 2 years (MS3/4?) . Wait you aren't comfortable with a Jan CA1 providing anesthesia to your 4 yr old while doing surgery?? Weird

No all are combined MD/DMD(DDS) and have to do the two years of med school. I think a minority are. My med school was that way, but the couple places I've been since then are not.

 

[GravelRider]

Pedi anesthesia isn't scary until you are well trained.

I'll take the 80 year old ASA 3-4 over a healthy kid any day.

 

[Ronin786]

I would never let a relative have any sort of anesthetic for a dental procedure in a freestanding dental center. Even with a board-certified anesthesiologist there, too many corners are cut for it to be safe enough for my comfort.

 

[Pharmado]

Not all OMFS people are MD/DMD. My brother-in-law completed residency 2 years ago. He completed dental school before going to residency. He had the option of doing the MS3/4 years and being MD/DMD vs simply doing the OMFS residency. He chose not to get the MD portion done. It isn't a requirement.

 

[AdmiralChz]

Wow, this is quite the video. Very sad stories. I have a few thoughts -

Some of these instances are oral surgery (OMFS) based as previously discussed. At my residency program they were with us 3-4 months and act as a CA-1, and get about 2-3 weeks of "pediatrics" (outpatient only) experience - they are pretty high level individuals as it seems very competitive to get in (some have a mix MD/DDS or DMD degree, some just DDS). But I wouldn't trust them doing anesthesia independently as an anesthesiologist (they didn't even finish a full year of training), and I would be even more concerned with them inducing general anesthesia and then turning around and doing surgery on the mouth with only a sedation nurse to monitor vitals - do they follow ASA standards, including ETCO2? I don't know, but I wouldn't be surprised if they don't.

So that is an issue. The other MUCH more troubling aspect is that pediatric dentists commonly induce deep sedation (or let's be honest, they probably do the "room air general" technique with oversedation) in their office. To my knowledge pediatric dentists don't do anesthesiology rotations like OMFS and thus aren't trained with administering general anesthesia, at least the training programs at the hospitals I've worked at haven't. That is absolutely terrifying! Just listen to that report on the first child who had anoxic brain injury - sedated with nitrous, "anti-anxiety" (likely Versed, but possibly Ativan/Valium) and Demerol. And this case was within the past two years. Terrible situation all around.

For what it's worth, the practice I'm joining after fellowship actually covers a couple dental offices for general anesthesia cases. I'm not sure if it's OMFS or general dentistry.

 

[MirrorTodd]

Well ****, I'm supposed to get my wisdom teeth removed in a couple months under sedation at my home institution.

 

[Noyac]

I'll take the 80 year old ASA 3-4 over a healthy kid any day.

Most would agree. Ped's is simple "usually".
It's just that the baggage is just so great if something goes wrong.
But, I still enjoy the pedi cases.
I've had two cases that really rocked me. Both were young pts in their early teens. Not what most here would call a pedi case. But the young ones stick with you for s long time. Neither one was was the fault of the medical team.

 

[anbuitachi]

Wow, this is quite the video. Very sad stories. I have a few thoughts -

Some of these instances are oral surgery (OMFS) based as previously discussed. At my residency program they were with us 3-4 months and act as a CA-1, and get about 2-3 weeks of "pediatrics" (outpatient only) experience - they are pretty high level individuals as it seems very competitive to get in (some have a mix MD/DDS or DMD degree, some just DDS). But I wouldn't trust them doing anesthesia independently as an anesthesiologist (they didn't even finish a full year of training), and I would be even more concerned with them inducing general anesthesia and then turning around and doing surgery on the mouth with only a sedation nurse to monitor vitals - do they follow ASA standards, including ETCO2? I don't know, but I wouldn't be surprised if they don't.

So that is an issue. The other MUCH more troubling aspect is that pediatric dentists commonly induce deep sedation (or let's be honest, they probably do the "room air general" technique with oversedation) in their office. To my knowledge pediatric dentists don't do anesthesiology rotations like OMFS and thus aren't trained with administering general anesthesia, at least the training programs at the hospitals I've worked at haven't. That is absolutely terrifying! Just listen to that report on the first child who had anoxic brain injury - sedated with nitrous, "anti-anxiety" (likely Versed, but possibly Ativan/Valium) and Demerol. And this case was within the past two years. Terrible situation all around.

For what it's worth, the practice I'm joining after fellowship actually covers a couple dental offices for general anesthesia cases. I'm not sure if it's OMFS or general dentistry.

They dont have standards. ASA means nothing to them. They dont even really recognize dental anesthesia according to the website above. Capno is not required according to the website.

 

[Mehd School]

Most would agree. Ped's is simple "usually".
It's just that the baggage is just so great if something goes wrong.
But, I still enjoy the pedi cases.
I've had two cases that really rocked me. Both were young pts in their early teens. Not what most here would call a pedi case. But the young ones stick with you for s long time. Neither one was was the fault of the medical team.

I witnessed what an experienced anesthesiologist at my home program called two "close misses" in peds cases. One was during my anesthesia elective month, the other during my ENT month. During one of these cases, the words crash cart were used. Both very simple, bread and butter cases. I had no idea what the hell I was looking at (still don't) but it was humbling for all in the room. In both cases the anesthesia was provided by a CRNA, and was caught/fixed in one case, and had to be caught/fixed by a dual boarded critical care/peds anesthesiologist the other time. It goes without saying that the general public (and even a lot in healthcare) truly have no idea how wrong and how quickly an "easy peds" case can go. I have a lot of interest in peds anesthesia in the future, and I will never forget the feeling I had in my gut watching these two kids crash during easy cases.

People that think they can safely provide anesthesia care to this patient population with a mere fraction of the experience is beyond my comprehension.

 

[deleted171991]

People that think they can safely provide anesthesia care to this patient population with a mere fraction of the experience is beyond my comprehension.

People are stupid. Once you accept that as a fact, you will only have pleasant surprises in life.

 

[deleted162650]

I'll take the 80 year old ASA 3-4 over a healthy kid any day.

Oh please. Kids are just little adults.