Safety and Comfort with Anesthesia at ORA
Narrator: Although stereotypes linger, a trip to the oral and maxillofacial surgery office is no longer the stressful and painful experience older adults remember. Today’s modern oral and maxillofacial surgeons provide patients with a very comfortable surgical environment and appropriate anesthetic to ease their discomfort and anxiety. Most oral and maxillofacial surgery take place in the OMS office; utilizing minimal sedation, moderate sedation, deep IV sedation, or general anesthesia.
The surgeon’s intensive anesthesia training, lifelong learning through didactic and hands-on continuing education programs and their self-regulated office anesthesia evaluations assure that patients receive the safest, most effective anesthesia care available.
Dr. Pogrel: Anesthesia was essential for the development of oral maxillofacial surgery. If you think about it, dental extraction is by far the most common surgical procedure carried out in the world and probably in every individual country in the world and to do it in a civilized manner requires anesthesia of some kind. Before we had anesthetics, surgery… first of all it wasn’t performed very often. When it was it was barbaric. Many of the early pioneers in our specialty were in fact pioneers in anesthesia in general because in a way anesthesia developed by way of dentistry.
Narrator: In the 1840s dentist, Horace Wells and William T.G. Morton, discovered the anesthetic effects of nitrous oxide and ether.
Dr. Pogrel: The early pioneers in the specialty of oral and maxillofacial surgery, were essentially looking for techniques that could be office based. People like Adrian Hubbell, Harold Krogh, were specifically looking for these outpatient techniques in the 1930s, 1940s, 1950s. They were instrumental in developing those techniques and making them safe and reliable techniques. They have certainly been adopted by some of the other medical and dental specialties.
Narrator: Today the administration of anesthesia is an integral component of the training every oral and maxillofacial surgery resident receives.
Dr. Herlich: The oral maxillofacial surgeon is unique among non-anesthesiology practitioners throughout the healthcare setting. In that the oral maxillofacial surgeon train side-by-side with anesthesiologists, physician anesthesiologists and under their direction.
Narrator: Oral and maxillofacial surgeons are trained so they have the ability to maintain patient safety.
Dr. Miloro: The training of the oral and maxillofacial surgery resident in anesthesiology includes both clinical and didactic exposure. In the classroom, setting residents are taught the basic principals of anesthesiology, as well as the pre-anesthetic assessment of these patients and management of complications. Clinically residents are exposed to a wide variety of outpatient clinical experiences, both in the adult and pediatric patient.
Dr. Ding: We continue with didactic sessions that include classroom setting, ACLS recertification. SimMan emergency scenarios, so our training is not just on a clinical basis with a one-on-one patient interaction. It continues outside the clinic as well.
Dr. Miloro: The oral and maxillofacial surgery-training program provides education and training in anesthesiology beyond what is typically required in the office setting. This allows the surgeon to be prepared for any situation, which they may encounter.
Dr. Pogrel: They then spend two and a half years in training perfecting their outpatient ambulatory anesthesia techniques until by the time they are fully trained, they have more training in outpatient ambulatory anesthesia then any other specialty.
Narrator: The administration of anesthesia is an essential skill that oral and maxillofacial surgeons continue to perfect through a lifetime of continuing education or CE. Oral and maxillofacial surgeons use a variety of anesthetic agents to ensure the comfort and safety of their surgical patients.
Dr. Olsson: The oral and maxillofacial surgery team consist of the surgeon, along with the dental anesthesia assistant and the surgical assistant. The oral and maxillofacial surgeon is ultimately responsible for all aspects of the surgical and anesthesia delivery.
Roni Lockhart: We help the doctor in administering the anesthesia. We monitor the patient before, during, and after the surgical procedure. We do go through training as the team and AAOMS has provided some wonderful resources for the dental anesthesia assistant. I enjoy all aspects of oral and maxillofacial surgery but I enjoy the intensive care that has to be given to a patient whose undergoing office anesthesia.
Edward Auyang: I had an excellent experience with the anesthesia. The team made me feel very comfortable. I had never undergone anesthesia before. At the same time, they were very informative as to all the stuff that I was going through. They made me feel very comfortable. It was essentially a painless procedure. After they had gotten me ready to go, I went to sleep and the next thing I knew I woke up and the procedure was over.
Dr. Herlich: The ASA and ALMS have a good working relationship in terms of preparation and patient safety. One of these areas is the office anesthesia evaluation manual. Those are parameters of care that the ALMS use for patient safety. ASA has reviewed all of these and have found these to be at the highest level of patient safety. Many of these include ASA standards of care.
Dr. Spina: I think the office anesthesia evaluation is very beneficial. I view the inspection as a blueprint. I use the office anesthesia manual as a guide. It helps me equip my office with proper equipment and monitors. All my emergency medications and I use the simulated emergencies, those scenarios to train my staff on a regular basis.
Dr. Banks: The AAOMS office anesthesia evaluation program is a prime example of how professional organizations and government agencies can successfully work together to assure patient safety. The American Association of Oral and Maxillofacial Surgeons developed its office anesthesia evaluation program nearly four decades ago and made it a requirement for association membership. When state governments begin establishing mandates for in office anesthesia administration, they often base their guidelines and evaluation programs on the thorough process of the AAOMS model or actually even adopted AAOMS’ Office anesthesia Evaluation Program.
Consequently, when I conduct an anesthesia evaluation of a colleague’s office, I do so not only as a representative of our association but also as an agent of the state of New Jersey.
Dr. Leathers: As we have seen, office based anesthesia provides many significant benefits, such as comfort and safety. However, none of these is more important than improved access to care for patients. As we know, many patients in our country have little or no insurance coverage, which can put surgical care in a hospital or outpatient surgery center beyond their reach. With the efficiency, flexibility and reduced cost of office based anesthesia, the same patients are more able and more likely to have their surgery performed in a comfortable and safe office setting.
Dr. Pogrel: Office based anesthesia as practiced by oral and maxillofacial surgeons is the safest anesthetic technique available today. With its short acting agents, its rapid induction, its light level of anesthesia, its rapid recovery, and it has an unparalleled safety record in anesthesia, and I might add, an unparalleled patient acceptance. Patients like this technique.