Dental Assistants Pushing Propofol etc...

  1. 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?
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    About Larry77

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    Associate Manager ED; from US
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    29 Comments

  3. by   noggin_wise
    You'd be hard pressed to find any dental office utilizing propofol on a routine basis.
  4. by   leesespieces
    [font=book antiqua]whoa! yes i think this is very unsafe practice!!!!! i'm sure it't all too common too, anyone remember the little girl in chicago that died within the last year from being oversedated during a routine dental procedure?! one afternoon is in no way long enough to teach someone arrhytmias! rn's take courses that last weeks to teach them arrhythmias. i am a nursing student, with 6 weeks left to go. we're on a tele floor right now and the only thing we've had time to be taught is a nsr pattern and a-fib and v fib. i still have a hard time with that!
    [font=book antiqua]
    [font=book antiqua]this is scary to me. but i guess the dentisits who allow untrained staff to push the sedation aren't that worried about their own licenses or they'd provide adequate training to their staff.
  5. by   NurseguyFL
    This one made me cringe. A dental assistant pushing propofol after just one afternoon of arrythmia training! That dentist must be crazy. And what's worse is that they are giving this drug without any BLS or ACLS training!!!!! What if the patient suddenly begins to go south. How would the assistant know what to do if they had to run a code?

    Even if the dentist is in the room, if something goes wrong and there's a lawsuit he's going to have a rough time explaining this to the lawyers and the Board of Medicine.
  6. by   HeartsOpenWide
    What is scary is a dentist that would allow this. I would not risk my medical license on this! It only takes about 2 mins, he should just do it himself; he already took the time to start the I.V.
    Last edit by HeartsOpenWide on Mar 30, '07 : Reason: typo
  7. by   Ariesbsn
    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?
  8. by   nrsang97
    NO WAY do I think this is safe. My mom had a filling done and the assistant NOT the dentist gave her the novacaine and she ended up with the tip of her tounge numb for one month since the assistant hit a nerve. The dentist already took the time to start the IV so he should give the med himself or hire a RN or CRNA to work in the office. If I were his patient and found this out I would be deffinately finding another dentist.
  9. by   Bluehair
    OMG! Yes, I have a big problem with this. In many facilities critical care RN's are not allowed to give propofol unless they have had specific training for conscious sedation, for all the reasons already listed (hypotension, respiratory depression, possible hypoxia, etc. etc.). I have seen some patients respond badly to this drug. Fortunatley it is short acting, but I would NOT feel comfortable with a dental assistant administering it to meor my family members. In some areas only Anesthesia staff are allowed to give it, period.
    Last edit by Bluehair on Mar 30, '07 : Reason: typo
  10. by   carachel2
    I walked out of an oral surgeons office because of the flippant attitude with conscious sedation. I have a history of cardiomyopathy and PSVT. I'm all clear now and do not take meds......but still, if you were doing conscious sedation on me wouldn't you at least want to see my rhythm and take a BP *before* you pushed it ?

    The oral surgeon started my IV (well, he missed my the AC on my right arm ) and proceeded to start with the meds.....I wasn't even hooked up to an oximeter or cardiac monitor and no BP had taken. I was incredulous.

    We rescheduled for another day with the OTHER surgeon that was supposed to be doing it in the first place. And yes, he did take vitals BEFORE he even started the IV.
  11. by   BabyRN2Be
    The dental assistants at my office don't even do nitrous without a physician present. Sounds pretty scary to me and I wouldn't put my life into hands like that. No way.
  12. by   TazziRN
    Sounds like one dentist that will never see the inside of my mouf!!
  13. by   PANurseRN1
    Quote from HeartsOpenWide
    What is scary is a dentist that would allow this. I would not risk my medical license on this! It only takes about 2 mins, he should just do it himself; he already took the time to start the I.V.
    Do they have the equipment if the pt codes? Who will manage the airway? Who would push the meds? Who would man the defib? The list goes on and on.

    If you are going to use those meds, then you had better be darned good and ready to be able to manage the problems that could result.
  14. by   RoxanRN
    Quote from noggin_wise
    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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