Oral surgery & dental office sedation

[CrunchRN]

I am having oral surgery with sedation at a very reputable oral surgeon here in town.

They do generals all the time for the oral surgery. However, I believe it is the surgeoun and a "tech" type situation although since I haven't been there yet to really check it out.

Any thoughts about safety? Should I tattoo "No CPR if you can't defribrilate" or something on my chest.

I guess I am just nervous about the non-hospital setting and the whole tooth implant surgery in general.

Anyone had this and care to relate their experience?

Thanks!

[BrnEyedGirl, BSN, MSN, RN, APRN]

just my $.02 here,.

have an RN friend who just took what I believe to be a very "cushy" job for an oral surgeon after spending 20 some years as a staff RN at a hospital,...they only do conscious sedation,..not general anesthesia (legally this would require an anesthesiologist),..lots of versed and fentanyl,..she is in charge of giving meds and monitoring the pt (BP, cardiac monitor, O2sats, pt's response),.the Dr and his "tech" work on the mouth,..crash cart is right there,.can intubate quickly if needed,...she said the only part that really made her nervous at first is that she is used to putting her pts on high flow O2 per NRB mask for conscious sedation,.can't really do that while someone is trying to pull teeth ,.......she loves the job,.and by "cushy" she works M-F, 9-5, no weekends, no nights, no holidays, her pts all go home at the end of the day and if it snows 8 inches the night before she gets a day off!!!!

Good luck with the appointment by the way!!!

[StacieRN, RN]

If the dental surgeon is reputable, the staff should be well prepared.

FYI my step-mom works for a dental surg. He is certified to teach ACLS and his entire staff is ACLS certified yearly. (my s-mom is the book-keeper and even she has to certify) He also goes over scenarios with the staff whenever there is a chance. I've had my dental procedures done at his office and am never worried.

Just call the office and ask the staff how they are prepared. Ask about defib access, emergency meds, ACLS cert, if there are RNs to recover you, etc.

I believe that's totally reasonable to ask. If they aren't willing to answer fully - I'd be looking for another surg.

[traumaRUs, MSN, APRN]

Conscious sedation or general anesthesia need to be administered by professionals, not techs, non-nurses, dental assistants! I too live in IL and last year had conscious sedation due to an abscess. The dentist was an MD/DDS and had an EMT-B "monitoring me." Yikes is all I can say! They actually were going to give propofol in this setting! No way for me. I asked for other agents and did fine. However, I would never return to this practice because I think I just lucked out and this practice is extremely dangerous.

Buyer beware!

[TrudyRN]

I personally dislike the idea of not being in or very, very near a hospital for any procedures involving anesthesia.

Just because an office has a crash cart doesn't mean anyone there really knows how to use the items on it. And having to be transported by a screeching ambulance, through town and country, over hill and dale, is not appealing at all.

I know many people have many dental, cosmetic surgery, and other procedures away from the hospitals every day. I think the odds are in your favor and wish you the very best.

[Insurance RN]

As already stated in previous repleis, there is a major difference between anesthesia and conscious sedation. In a previous job, I was the RN for an oral surgeon and did all the conscious sedations. My main responsibilities were to monitor VS, the airway, start the IV and administer the medications as ordered. Conscious sedation is a very safe procedure, the side efffect I saw most often was pateints vaso vagaling down when I tried to start the IV (usually young guys...LOL). Please check out the office, at minimum there should be a heart monitor with attached O2 sat monitor and automatic BP cuff, O2 outlet (we gave 2L O2 via NP) and emergency equipment and meds.

After the procedure, I was responsible for recovering the patient.

Good luck and I hope this helps.

[redding6]

I can understand the hesitation to have general anesthesia in an out patient arena but I can assure you that, as an Oral Surgery RN, our clinic performs a variety of procedures every day with IV or conscious sedation as well as general anesthesia and have had no, as in none, adverse outcomes. The Oral Surgeon's training include rotations in anesthesia and their boards include passing anesthesia testing. Having an ETT in the mouth while extracting wisdom teeth is no problem. Every patient is monitored with NIBP q 5", and SP02, ECG and Respiration continually. The patient is recovered in the procedure chair for at least 30" post the last administered IV drug and 60" post general anesthesia and then released only with an escort who promises to remain with the patient for the duration of the day. The office personnel are trained to recognize a variety of emergent situations and we have mock codes quarterly. The crash cart gets checked every day and the Oral Surgery tech's know how to perform the initial actions in any scenerio even though they do not push meds, they do start IV's and can place defib pads as well as charge the Zoll. The surgeon would be the on e who would administer the ACLS drugs and the defib charge itself if I wasn't there. Personally, prior to working in the Oral Surgery Clinic I would have been skeptical also, but I would go under the gas in my clinic today if I had to without any fear.

I hope this helps put you at ease regarding your upcoming surgery.

[CrunchRN, ADN, RN]

Thank you so much to everyone for their input.

I have my consult tomorrow and I will ask the questions you have brought up.

I thank the last poster also for the reassurance, and all the others for bringing up the questions I should ask.

My first question will be is there an RN in the office?

I do have a really great friend who is a CRNA and would go with me, but I hate to ask.

I have had MAC sedation and general before and I am healthy so i should do fine. I have also checked the rep of this practice and they are very reputable.

I will let you know what i find out in case anyone is curious.

Does anyone have any idea what to expect after the first procedure discomfort wise?

[meandragonbrett]

If there was no anesthesia provider there doing the sedation. I would not be having the procedure done there. Just my own personal preference.

[HealthyRN]

Personally, I would not have general anesthesia done in an oral surgeon's office. However, a few months ago I had my wisdom teeth removed and I did have conscious sedation. They gave me a very small dose of Versed (2mg). I still remember everything that happened, but I was very relaxed and had the feeling of just not caring. They were monitoring SpO2, HR, and BP during the entire procedure. Everything turned out fine.

[Dental Hygienist]

For what it's worth; in the state of Oregon an Oral surgeon cannot do general sedation without the assistance of an anesthesiologist or a nurse anesthetist; and oral surgeon by himself can do various levels of deep sedation including IV sedation; but not general sedation. This rule was recently changed (less than 7-10 years ago I'd guess) and previously they COULD do general sedation.

I'd imagine that it varies from state to state, so it's worth asking WHO will be administering and monitoring your general sedation. But apparently at least some states believe that the surgeon in charge of the actual procedure shouldn't be the same person in charge of your life with the anesthesia; too easy to get overwhelmed or sidetracked I'd guess.

Anyways, I hope that helps!

[crissrn27, RN]

Where do you people get this lovely sedation at, lol. I had an abscess a few weeks ago, that turned into a huge sinus abscess, and the ENT just did a local, which caused so much pain that I screamed and :barf01:After which she did an I an D on the not numb space. NOT FUN.

We have no sedation dentist (or ENT, lol) around here. Have to go out of town, if you want this, and from what I have heard they were very well prepared, but that was just sedation, not general. Don't know if I would do general in the office.

[Medic/Nurse, BSN, RN]

Here is my END GAME! (Hope that there is no need for irony in this!!)

I had a dental experience go horribly wrong a couple of years ago and I ended up exceptionally upset and in the oral surgeons office. I was offered various "types" of sedation/analgesia and I elected to go with Nitrous and Local. I did okay. I am due for a dental implant and I may go a more "sedated" route! (Prior TRAUMATIC experience )

Unless I KNOW that my AIRWAY can be managed well by the medical staff present - I will not do any options that compromise my ability to protect my own airway. (If you are not alert enough to stick out your tongue - you are UNABLE to protect your own airway!)

I have also done a few plastic procedures with the same rules! No problems.

But, I am getting to a point that I may NEED additional options as some things are a bit more involved (I am getting a bit older - ). I have decided that I will take a "support" person that I will insist on being able to witness my "experience". Yep, you may have guessed it! This SUPPORT person will be one of my paramedic partners (yep, ADVANCED LIFE SUPPORT may be the BEST KIND!) and will have ACCESS to whatever may be needed to SAVE my LIFE! The most important thing for ANYONE to have access to in these situations is KNOWLEDGE - so use it!

Thankfully, my paramedics love me just a little - but, I admit this kind of love comes with a price!!! Sure, sweetie I'd LOVE to accompany you to get your eyes done, NAH - I don't have ANYTHING else I'd RATHER do!!! (I am a lucky girl!!!) :)

Practice SAFE!