Dentist Anesthesiologists Research Articles

How Safe Is Anesthesia Management by Dentist Anesthesiologists? The Need for an International Collaborative Study on the Safety of Anesthesia Management by Dentist Anesthesiologists.

How Safe Is Anesthesia Management by Dentist Anesthesiologists? The Need for an International Collaborative Study on the Safety of Anesthesia Management by Dentist Anesthesiologists.

Japanese Dental Society of Anesthesiology Celebrates 50 Years.

The Japanese Dental Society of Anesthesiology (JDSA), with ∼2600 members, celebrated its 50th anniversary with a special banquet after its annual scientific session at the Imperial Hotel Tokyo on Sunday, October 30th, hosted by JDSA President, Professor Takehiko Iijima. Professor Emeritus Yuzuro Kaneko gave the celebration address titled “The History of Japanese Dental Anesthesiology.”Dental anesthesiology in Japan began with physician anesthesiologists who saw the need to train dentists to provide anesthesia for dental and oral & maxillofacial surgery. Professor Yasuya Kubota, a physician who later trained as a dentist, opened the first dental anesthesiology department in Japan at Tokyo Medical and Dental University in 1967. Gradually, virtually every dental school opened their own separate department in the 1970s and 1980s, and these departments began dental anesthesiology residency programs. To manage patients who required hospital admission following surgery, dedicated dental hospitals run jointly by dental anesthesiology and oral & maxillofacial surgery emerged with some facilities having dedicated intensive care units for patients requiring intubation following surgery, such as for head and neck cancer surgery and, as was common in the past, orthognathic surgery. Dental anesthesiology was recognized as one of only 5 dental specialties by the Japanese federal government in 2006.The Japanese Board of Dental Anesthesiology (JBDA) was formed to assess competence in anesthesia care in 1977. With time, 2 examinations were developed – Board Certification (1336 dentists) and Specialist Certification (339 dentists). The examination for JDBA board certified dentists occurs after 2 years of dental anesthesiology residency and allows these dentists to provide conscious sedation (as it is referred to in Japan), including the use of propofol to achieve this level of sedation, in private dental offices. Specialist Certification allows for general anesthesia to be administered in dental offices and generally requires an additional 3 years of training. Oral & maxillofacial surgeons may also provide conscious sedation after their residencies. Unlike in the US, conscious sedation guidelines recommend that the sedation dentist does not participate in the surgical procedure. Deep sedation and general anesthesia may only be provided by dentist anesthesiologists dedicated to anesthesia provision as is the case in all other parts of the world other than North America.At the 50th Anniversary Celebration, congratulations were offered by the presidents of the Japanese Society of Dental Sciences, the Japanese Dental Association, the Japanese Society of Anesthesiology, and various elected officials representing several agencies of government. Greetings and congratulations from the ASDA and the ADSA were made by Dr. Steven Ganzberg, who also lectured at the annual scientific session.We applaud the outstanding research and high level of clinical activity by dental anesthesiology in Japan. We in the US are all proud to have Japanese dental anesthesiologists as our colleagues. We wish the JDSA continued success as we celebrate 50 years of dedication to the art and science of dental anesthesiology with them.Respectfully submitted,

Regulatory barriers to dental anesthesia services for special populations.

Sedation and general anesthesia are necessities for the treatment of many individuals within special populations such as those with physical and intellectual disabilities, fear/anxiety, or individuals requiring extensive procedures. This study aims to discover regulatory factors that may be contributing to the limited access to anesthesia services provided by dentist anesthesiologists. The study included an online survey completed by self-reported dentist anesthesiologists with 2 or more years of formal anesthesia training. The survey was distributed at the April 2019 American Society of Dentist Anesthesiologists national meeting in Chicago. Participants responded to questions regarding the effect of specific state regulations on decisions to practice in a particular state and how such regulations influenced patient safety and barriers to care. Rules and regulatory restrictions on the mobility of dentist anesthesiologist equipment/supplies and additional state narcotic transportation regulations were deemed statistically significant in failing to improve safety. Requiring airway and sedation training for a facility's provider and staff were not barriers to care. Rules and regulations were not a factor to establishing clinical practice in one state over another state. Individuals and organizations responsible for influencing the regulatory environment of anesthesia services should improve regulations to facilitate the mobility of dentist anesthesiologists.

A Survey of Dentist Anesthesiologists on Preoperative Intramuscular Sedation.

The induction of general anesthesia for children and patients with special needs frequently requires preinduction sedation, especially when anxiety and agitation lead to violent or combative behavior. In these situations, preoperative intramuscular (IM) sedation may facilitate patient transfer, intravenous cannulation, and/or mask induction. This survey aimed to capture data regarding the current preoperative IM sedation practices of dentist anesthesiologists. An electronic survey was distributed in 2020 to all members of the American Society of Dentist Anesthesiologists regarding the administration of preoperative IM sedation. It included questions about the demographics of respondents and their patients who require IM sedation, the most common drug regimens used, decision-making criteria regarding ketamine dosing, the intended level of sedation, sequence of anesthetic management following IM sedation, and observed outcomes. A total of 193 responses (43%) were received; of those, 162 reported using preoperative IM sedation. Ketamine was included in 98.7% of reported IM drug regimens. The most common IM sedation regimen was combined ketamine and midazolam (median 2.5 mg/kg and 0.1 mg/kg, respectively). Of the respondents who use preoperative IM sedation, 87% reported using the same drug regimen in at least 80% of cases. The most frequently reported drug regimen used by dentist anesthesiologists in North America for preoperative IM sedation was a combination of ketamine and midazolam.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

Curious Case of the Pretracheal Stethoscope

Curious Case of the Pretracheal Stethoscope

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

Recent Changes to Anesthesia Progress.

Recent Changes to Anesthesia Progress.

Tribute to Harcourt M. Stebbins, DDS, Colonel (Ret), USAF.

Tribute to Harcourt M. Stebbins, DDS, Colonel (Ret), USAF.

The ADSA Ten Minutes Saves a Life! App

The ADSA Ten Minutes Saves a Life! App

Illinois Dental Anesthesia and Sedation Survey for 2016.

A statewide decennial survey was sent to practicing dentists holding sedation or general anesthesia permits to identify office sedation/general anesthesia trends and practices over the last 10 years. This survey constitutes the third such survey, spanning a total of 20 years. Of the 234 respondents in the 2016 survey, 34% held an Illinois moderate sedation permit and 64% held a general anesthesia permit. Oral and maxillofacial surgeons represented the majority of respondents (143/234; 61%). The remainder of responses were from general dentists (39; 17%) pediatric dentists (32; 14%), periodontists (16; 7%), dentist anesthesiologists (3; 1.3%) and 1 periodontist/dentist anesthesiologist. Surveys over the 20 years revealed the following significant trends: an increase in practitioners current in advanced cardiac life support certification, an increase in the number of non-oral maxillofacial surgeons with a sedation permit, an increase in providers of moderate sedation, and an increase in offices equipped with end-tidal CO2 and electrocardiogram monitoring. However, a number of providers were identified as not compliant with certain state mandates. For example, many respondents failed to meet minimum office team staffing requirements during sedation, hold semiannual office emergency drills, and establish written emergency management protocols.

Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology.

Supplemental Digital Content is available in the text.

IFDAS 2018 Meeting News.

The 15th International Federation of Dental Anesthesia Societies (IFDAS) International Dental Congress on Anesthesia, Sedation, and Pain Control, in Nara, Japan, was a huge success. This was a joint meeting with the Japanese Dental Society of Anesthesiology (JDSA), the specialty association of dental anesthesiologists (as they are called in Japan), and the Federation of Asian Dental Anesthesiology Societies, made up of physician anesthesiologists with an interest in, or practice devoted to, anesthesiology for dentistry from other Asia/Pacific countries and including JDSA. Over 1000 participants were involved in the various lectures, symposia, poster presentations, and oral research presentations of the 3 groups.Representing the United States and Canada were a particularly large number of dentist anesthesiologists, including such luminaries as Drs Joel Weaver, Daniel Haas, Mort Rosenberg, James Phero, and Stanley Malamed. Several US oral and maxillofacial surgeons also attended, including ADSA president Dr Michael Rollert, who eloquently represented ADSA. Dr Cynthia Fukami represented ASDA as president-elect. Invited US speakers included Drs Joel Weaver and Steven Ganzberg. Drs Jason Brady and Andrea Fonner, along with a host of ADSA members and dental anesthesiologists from Japan, presented a beta version of the 10 Minutes Saves a Life app to our colleagues from all over the world. The app should be available before the end of the year to all ADSA members!Dr Joel Weaver, a consummate historian, gave the JDSA Yasuya Kubota Memorial Lecture on the legacy of Japanese and American pioneers in dental anesthesiology. A special session titled Young IFDAS was a great success, with younger (and older) dentist anesthesiologists and sedation providers from all over the world discussing sedation and general anesthesia in their respective countries. A number of presentations related to facial pain and its management were also presented.Dr Daniel Haas, dentist anesthesiologist, Dean of the Faculty of Dentistry, and Head of the Department of Dental Anesthesiology at the University of Toronto, was one of the recipients of the Horace Wells Award recognizing exceptional careers in pain and anxiety control in dentistry. He is the first Canadian to be awarded the honor. Dr. James Phero, dentist anesthesiologist and past ADSA and IFDAS president, also received this high honor from the IFDAS.The IFDAS and JDSA put on an exceptional program headed by Dr Tatsuya Ichinohe with congress president Dr Katsuhisa Sunada. The logistics were quite complex with so many different meetings in so many languages going on simultaneously. As we have come to expect from our Japanese colleagues, the event was flawlessly presented. The Noh theatre performance, an ancient Japanese tradition, and the Taiko drummers during the evening presidential reception were beautiful. The geisha performance at the very sophisticated gala dinner the next night was exquisite and completed the highlights of the long history of Japanese culture. In short, the 15th IFDAS meeting was a tremendous experience for all who attended and had the opportunity to expand their vision of dental anesthesiology on what felt like a very small planet. Make your plans now to attend IFDAS 2021 in Moscow, Russia.

Practice Patterns of Dentist Anesthesiologists in North America.

This study provides trends in the discipline of dental anesthesiology. A questionnaire-based survey was sent to 338 members of the American Society of Dentist Anesthesiologists to evaluate practice patterns. One focus of the study was modality of sedation/anesthesia used for dentistry in North America. Age, gender, years in practice, and geographic region of practice were also obtained. Data gathered from the returned questionnaires were entered into an Excel spreadsheet and then imported into JMP Statistical Discovery Software (v12.2 Pro) for descriptive analysis. A total of 112 surveys were completed electronically and 102 surveys were returned via post, for a total response rate of 63.3% ( N = 214). Data from this survey suggested a wide variation of therapeutic practices among dentist anesthesiologists in North America. Of the surveyed dentist anesthesiologists, 58.7% (SE = 4.2%) practice as mobile providers, 32.2% (SE = 3.1%) provide care in an academic environment, and 27.7% (SE = 2.8%) function as operator/anesthetists. The majority of anesthesia is provided for pediatric dentistry (47.0%, SE = 4.2%), oral and maxillofacial surgery (18.5%, SE = 3.9%), and special needs (16.7%, SE = 3.6%). Open-airway (58.7%, SE = 5.5%) sedation/anesthesia was the preferred modality of delivery, compared with the use of advanced airway (41.3%, SE = 4.6%). The demographics show diverse practice patterns of dentist anesthesiologists in multiple regions of the continent. Despite concerns regarding specialty recognition, reimbursement difficulties, and competition from alternative anesthesia providers, the overall perceptions of dentist anesthesiologists and the future of the field seem largely favorable.

American Society of Dentist Anesthesiologists: Parameters of Care.

American Society of Dentist Anesthesiologists: Parameters of Care.

Emerging Demand in Pediatric Dentistry for Office-Based General Anesthesia by Dentist Anesthesiologists in the United States

Emerging Demand in Pediatric Dentistry for Office-Based General Anesthesia by Dentist Anesthesiologists in the United States

The FDA Warning on Anesthesia Drugs.

The FDA Warning on Anesthesia Drugs.

Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients.

The number of children with caries requiring general anesthesia to achieve comprehensive dental care and the demand for dentist anesthesiologists to provide ambulatory anesthesia for these patients is increasing. No current published studies examine the safety and outcomes of ambulatory anesthesia performed by dentist anesthesiologists for dental procedures in pediatric patients, and there is no national requirement for reporting outcomes of these procedures. In 2010, the Society for Ambulatory Anesthesia Clinical Outcomes Registry was developed. This Web-based database allows providers of ambulatory anesthesia to track patient demographics and various outcomes of procedures. Our study is a secondary analysis of data collected in the registry over a 4-year period, 2010-2014. Of the 7041 cases reviewed, no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events. Of the 7041 cases reviewed, 196 (3.0%) resulted in a predischarge or postdischarge adverse event. The predischarge adverse event occurring with the highest frequency was laryngospasm, occurring in 35 cases (0.50%). The postdischarge adverse event occurring with the highest frequency was nausea, reported by 99 patients (5.0%). This study provides strong clinical outcomes data to support the safety of office-based anesthesia as performed by dentist anesthesiologists in the treatment of pediatric dental patients.

Letter to the Editor.

Anesthesia Progress recently published an article titled “Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist.”1 The introduction of this retrospective analysis refers to an article published by Bennett et al2 in the Journal of the American Dental Association that asked the question as to the safety of deep sedation or general anesthesia in the dental office. In that article, the authors provide OMSNIC data, which has been shared at numerous meetings of the American Association of Oral and Maxillofacial Surgeons and American Dental Society of Anesthesiology. The numbers reported that of an estimated 39.4 million anesthetics administered over a 14-year period, there were 113 cases that resulted in death or brain injury, which is an occurrence of 1 injury per approximately 350,000 anesthetic procedures or 1 injury every 6.4 weeks. Oral and Maxillofacial Surgery National Insurance Company (OMSNIC) insures an estimated 80% of practicing surgeons. The authors, therefore, estimated that if the 20% of oral and maxillofacial surgeons not insured by OMSNIC had a comparable occurrence, the potential anesthetic morbidity and mortality would approach 1 occurrence every 5.4 weeks. Unfortunately, as Bennett et al stated, a national safety center in which anesthetic outcome is assessed is not available.Oral and maxillofacial surgery (OMS) has striven to provide optimal care for its patients. The numbers reported above have been provided over the years in conjunction with anesthetic safety presentations in which the specialty has openly assessed adverse outcomes and processes to take to avoid such in the future. Missing from those numbers is what transpires in the non-OMS offices. From the information available, Bennett et al estimated that the occurrence of morbidity and mortality in all dental offices exceeds 1 every 4 weeks. Reebye et al1 incorrectly quoted Bennett et al in attributing the occurrence of more than 1 death or brain injury every 4 weeks to OMS, in which the statement reflected an estimated occurrence in all dental offices. This was probably a conservative estimate, and the occurrence per week of anesthetic morbidity and mortality associated with enteral and parenteral sedation and general anesthesia in non-OMS offices is probably comparable to that which occurs in OMS offices with a significantly smaller number of anesthetics administered. Unfortunately, without any national data reserve reporting death or brain injury as well as adverse anesthetic events, the dental profession cannot completely learn from these occurrences to minimize their occurrence in the future.The authors chose to report the numbers in the manner reflected of occurrences per week. When reported as an occurrence of 1 per every 350,000 anesthetics, the perception is different than when reported as 1 every 5.4 weeks. The first numbers reflect the safe delivery of anesthetic care; the latter asks if there is anything that can be done to optimize care. The article wanted to put the focus on the need to not be complacent but to continue to advance the delivery of anesthesia, which the OMS specialty is doing with the focus on advancing simulation training and team development.Nobody desires to minimize the tragedy associated with an adverse outcome. The goal of patient care is to do no harm. Patient safety is critical to patient care. The dental patient is getting older, more medically compromised, and taking more medications. Dental education, however, is minimizing the importance and time allotted to biomedical sciences and their application in the didactic and clinical curriculum, yet there are those who are encouraging and facilitating individuals with inadequate medical foundation to provide anesthetic services with little training. We always applaud individuals to assess what and how they provide care. Reebye retrospectively assessed the care that he provided. As the article correctly stated, there is bias in a retrospective data assessment, and a prospective study would be required to provide any recommendation to determine if the difference in the anesthetic delivery system is both of clinical significance and not just statistically significant. We feel that the article by Reebye et al1 incorrectly used the morbidity and mortality data from our publication to establish a foundation against the OMS surgical anesthetic team. Various practice models exist within dentistry for the delivery of anesthesia from sedation to general anesthesia. Safe deep sedation and general anesthesia is provided in OMS offices daily. It is important, however, for all dentists to understand that safe anesthesia practice is dependent on the following: appropriate patient selection; selection of an appropriate anesthetic depth; use of appropriate monitoring (considering beneficial or necessary redundancy in respiratory monitoring)3; equipping the office with the appropriate emergency medications, supplies, and instrumentation (including cognitive aids to provide recall in crisis situations); and a well-trained surgical/anesthetic team4 that routinely participates in simulated emergencies.