Dental Assistants Pushing Propofol etc...

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I was talking to an oral surgeon friend of ours and we were discussing his sedation procedures that he does in his clinic. I was amazed to find out that while he is the one to start the IV's on the patients his dental assistant is the actual person who administers the propofol/fentanyl boluses.

He says that his assistants do go to a one afternoon training on how to recognize lethal arrhythmia's but do not get their ACLS or even BLS. He also says that his assistant is not allowed to administer meds without him in the room.

I talked to my wife about this who is a dental assistant and she says the way that dental gets away with this is that the assistants are working under the dentist's license, not their own.

I was just wondering if others thought this was an unsafe practice?

Specializes in CCRN, CNRN, Flight Nurse.
You'd be hard pressed to find any dental office utilizing propofol on a routine basis.

My daughter had her wisdom teeth out 2 weeks ago. I was present for the 'induction' of the sedation. The oral surgeon (an MD, not DDS) started the IV and pushed the drugs.... propofol, ketamine, versed, and decadron. She was on a cardiac monitor, pulse ox, BP monitoring and O2. Also available in the room was airway management equipment (BVM, intubation supplies, etc). I'm sure a crash cart was around somewhere, just out of sight.

As far as the qualification of the staff, unfortunately, I don't know. However, I would guess RNs.

It's probably the difference in dentist's office's and oral surgeon's office's.

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

This is why my wisdom teeth are still in my mouth and that is where they will stay until a real problem arises!!! I do not trust anyone besides and anestesiologist or CRNA to administer such drugs especially since I have never had surgery and have no idea how I will react to such drugs, heck I have never even had narcotics so I would probably be a light weight..

Swtooth

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Specializes in Geriatrics, MS, ICU.

Wow! That is a very scary thought! That Dentist is either really-really confident or not very bright. I cannot even imagine if someone had a reaction! Very frightening thought!

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Specializes in Trauma/ED.

It's probably the difference in dentist's office's and oral surgeon's office's.

The said Dentist is an oral surgeon with anesthesia endorsement to allow him to do this in his office.

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Specializes in Hospice, Med/Surg, ICU, ER.

Oh for God's sake!

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Ok, what about the hypotension and respiratory depression that can come with both of these drugs? I wonder how long the class was that covered that?

I agree and also would like to know who is watching the patients in recovery after the oral surgery? It is bad enough that the dentist is performing oral surgery and allowing an untrained person to push propofol of all things and probably a whole host of other things as well, I would think he might be a bit too busy with his duties in the room already and may have a hard time monitoring everything while he is performing the surgery...which is unsafe because it isn't the best situation for supervision. But even if all goes well during the surgery this patient is at risk for respiratory depression and respiratory acidosis from hypoventilation. Is the dental assistant or person monitoring the patient in the recovery room going to be able to recognize the signs and symptoms and no what to do if the body is unable to compensate for this? :uhoh21: :nono:

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

my personal opinion is that there is no way in (well you know where) that i would allow a dentist or a dental assistant push anything on me...when i was inquiring about oral surgeries (in office) i made sure there was a rn present. my children's dental stuff was done in the hospital...as a matter of fact my 6 year old had dental surgery today...

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My daughter had her wisdom teeth out 2 weeks ago. I was present for the 'induction' of the sedation. The oral surgeon (an MD, not DDS) started the IV and pushed the drugs.... propofol, ketamine, versed, and decadron. She was on a cardiac monitor, pulse ox, BP monitoring and O2. Also available in the room was airway management equipment (BVM, intubation supplies, etc). I'm sure a crash cart was around somewhere, just out of sight.

As far as the qualification of the staff, unfortunately, I don't know. However, I would guess RNs.

It's probably the difference in dentist's office's and oral surgeon's office's.

Hate to say this but Oral Surgery is a branch of dentistry. Dentists perform a residency, take boards and then are certified for oral surgery.

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Specializes in CCRN, CNRN, Flight Nurse.
Hate to say this but Oral Surgery is a branch of dentistry. Dentists perform a residency, take boards and then are certified for oral surgery.

This doctor is an MD as are the other doctors in the group. I have never heard of oral surgeons being anything other than MD.

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Specializes in Critical Care, Emergency, Education, Informatics.

http://www.aaoms.org/oms.php

I'm sorry, I've been doing this for almost 30 years now. Oral surgeons have been doing this kind of stuff in their offices for decades. The medications change but the results and risks are the same.

There is a lot of misinformation from both sides, emotion, and very little "evidence" from both sides. There is lots of anecedotal stories and a few real disasters. But then again, I've seen disasters happen in the highest ranked hospital in the county. It happens. There are incompitent DDS, MDs, DO, CRNA's, RN, LPNs you name the alphabet. These people need to be weeded out of the system by reporting the facts as they happen. And yes we as nurses are in a unique position when it comes to that.

I've seen apnic patients after 5 mg of valium for cardioversion, and I"ve seen pt's get hypotensive after 50mcg of fentanyl. I've seen a nurse and pharmacist get the decimal point wrong and give 100 times the aminophyline dose to a patient. I personally survived an RN in an ER who had CEN, & CCRN after her name on her name badge, giving me 2mg of Dilaudid RAPID iv push. My body disapeared and my resp rate went to 6. My wife who is a PA and was a paramedic for 20 years kind of chewed her out, after she put me on O2.

Lets keep the emotion and screaming out it. Before we open our mouths we need to have facts, not supposition or what we think is right, but the facts.

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Specializes in ER.

There is no way in hell I would allow them to do that to me. I would insist on at least two ACLS providers in the room, and emergency airway supplies, and I would ask how often they update their skills hands-on. If someone hasn't intubated successfully at least five times in the last year I'm not putting my airway in their hands. For a dentist that would require a significant committment to his/her patient's safety, and that's the guy I want for my provider.

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Whew!!! Let me clear some things up here. I am a RN X 22 years, 15 in ICU/CCU, 4 in PACU and now 2 in an Oral Surgery Clinic. We do IV sedations as well as general anesthesia, IN THE CLINIC, for a variety of procedures but mostly extraction of wisdom teeth, aka 3rd molars. Our Oral Surgeons are certified in anesthesia as part of their residency and we perform AGA or general anesthesia every Thursday. They intubate weekly, in the clinic, pediatric as well as adult patients. We have two anesthesia machines as well as a crash cart so access to airway equipment is no more than arms length in the procedure rooms. The IV sedations are done four days a week. The assistants actually start the IV's. They have all attended a hospital sponsored IV Phlebotomy class and then have to perform 20 IV starts under supervision before being allowed to start an IV unsupervised. They are pretty good at it too! The surgeon draws up the medications and gives the initial doses of Fentanyl and Versed, no propofol, until the patient is in a "moderate sedation" status, vital signs stable and patient is responsive to verbel stimuli. The surgeon wears a listening device in his or her ear which is attached to a head placed on the patients chest at the trachea/corina area so the sounds of inspiration and expiration are being monitored constantly by the surgeons left ear. The cardiac and respiratory alarms are set on the overhead monitor which displays rhythm, SPO2 including waveform, and NIBP q 5 minutes. One assistant scrubs in sterile with the surgeon and another assistant is the monitor/circulator, never leaving the room. Vitals are charted q 5 minutes. This is when the surgeon may ask the assistant to give the patient another small dose of Fentanyl or Versed. During the procedure if the patient starts complaining of pain or starts moving in the chair becoming restless, additional doses of Fentanyl or Versed are given but in very small amts. Propofol is only given with the general anesthesia procedures. Although I am the only RN on staff, the assistants have demonstrated to me in real situations that they are competent in recognizing critical changes in a patients condition and they do know how to call a code, retrieve the crash cart and perform BLS. The only time an assistant "pushes" a drug is under the direct visual supervision of the surgeon who is performing the surgery and he tells the assistant exactly how much to give in volume amounts not doseage amounts, in other words, he or she may say to push another 1ml of versed. When general anesthesia is given, one surgeon is administering the anesthesia and another is performing the surgery. I recover the patients in the clinic and discharge them according to PACU standards.

Hope this eases the worries of those who thought the assistants were "pushing" the drugs on the patients the same way RN's are managing sedation and pain in the ICUs .

Thanks

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