scary.....

oral surgeons claim to spend an extra year learing how to do anesthesia

but when do you think the last time he intubated was

I'm sure that's exactly what athomas was looking for alan.

LOL

the required anesthesia exposure for an oral surgeon is exactly 3 months.... the good news is that if they knock out any teeth with their intubation, they can fix it....

My daughter had 4 teeth pulled (for orthodontics) this summer. The oral surgeon used propofol and versed with no problem. I guess since I use propofol so much in the ICU, I never even worried about it. Light dose, quick half-life. Heck, I was more worried about the versed than the propofol.

One difference between your situation, though -- there were TWO oral surgeons present. One for the surgical procedure, another to manage the "anesthesia." Plus a dental assistant.

Don't underestimate the effects of these strong drugs. Last week, I gave a test dose (something I rarely do anymore) of propofol, turned around for a quick check of the oxygen flow, turned back to an apneic patient. She had versed 1.0 mg about 5 minutes before. She was fine after positive pressure oxygen. By the way, she was 25 and in excellent health, but a real light weight regarding anesthesia.

Yoga

the problem with propofol is that it truly is a GENERAL anesthetic... by definition a MAC is light sedation with the patient able to follow simple commands. Propofol abolishes most airway reflexes.... In fact, at our hospital the only place for propofol is in the hands of an anesthesia provider or in the ICU setting for a ventilated patient... So while it is a great drug, and has a relatively short half-life - overdosing is very, very easy... and the person using it must feel very confident in being able to manage the airway...

Propofol is a vastly flexible agent, capable of inducing general anesthesia, or, with metered titration, varying degrees of sedation. Syringe pumps such as the Bard InfusOR provide highly responsive flexibility, often likened to stepping on the gas pedal : more awake, more sedated, all within seconds. The short onset and short duration of propofol make it useful beyond induction/maintenance of general anesthesia.

It's all in how it's applied.

propofol - while short onset and short duration of action, it still hangs around your body. Elimination is triphasic, with the distribution half-life being 2-10 minutes; the second phase half-life being 21-56 minutes; and the terminal elimination half-life 1.5 to almost 30 hours. and it is unbelievably synergistic (not only additive) with benzos and narcotics, so therefore you want to make sure you know how to manage the airway when it is used.... and the only people i know who have a clue on how to manage an airway are oral surgeons, anesthesia providers and a very small percentage of Medics.... Nurses don't know, ER docs don't know, etc.... so while it CAN be titrated and used for sedation, and it looks easy (just turning a dial...), you better make sure somebody is monitoring that airway

other issues and possible adverse effects with propofol (as discussed during its Phase IV trials for sedation/ICU uses)

1) unrecognized airway obstruction

2) silent aspiration due to loss of pharyngeal reflexes

3) bradycardia

4) hypotension

5) myoclonus/opisthonos (mainly in children and young adults)

6) agitation

7) hypoventilation with concomitant respiratory acidosis

a few things to keep in mind for what appears to be such an "easy" drug

Originally posted by Tenesma

propofol - while short onset and short duration of action, it still hangs around your body. ................

a few things to keep in mind for what appears to be such an "easy" drug

No idea where the 'easy' reference originates. Flexible drug, yes. Anyone who believes MAC anesthesia to be easy lacks sufficient clinical experience. In fact MAC can require a high degree of subtlety in technic -- artistry even -- and is far more difficult to pull off satisfactorily than a slam-dunk GETA.

As to oral surgeons doing their own sedations, that has always seemed to me to be like a guy driving down the highway with one arm around a pretty girl: driving, or the girl -- he can't do full justice to either one.

"easy" :)

i was being facetious

well i am glad that my concerns were not unfounded - like i said in the end - i am still breathing

and this doc doesn't use narc's during his procedures... but i have to say - i woke up on top the world - my husband got a kick out of it - don't feel so hot now....

I think most anesthesia providers agree that people who don't do anesthesia daily probably should not be giving anesthesia drugs. I've heard or read about ER docs whose favorite sedating agent is propofol, and some have mentioned that they think ketamine is better for sedating kids. We have oral surgeons using, as indicated in this thread, propofol and other anesthesia agents.

There is a reason they are called "anesthetic agents" as opposed to "sedation agents." Yes, you can "with the turn of a dial" change the depth of most patients' sedation when using propofol. However, there is an extremely fine line when using this drug between "sedation" and "apnic" and "dead." You don't really have an appreciation for that until you see, through experience, how fine that line can be. Generally, in the hands of a competent MDA or CRNA, these are great drugs. But we are ready for the patient who stops breathing with 30 mg propofol on board (and I've seen that happen). A dentist, as good as s/he may be, just isn't ready. And I've noticed that anesthesia providers spot apnea long before just about any one else in the room.

I'm rambling a bit, but the point is that the ASA and the AANA are both right. Anesthetic drugs should not by administered by anyone unless they are anesthesia providers. Or at a minimum, by a health care professional under the direct supervision of an anesthesia provider. Like it or not, this isn't an issue of turf, or money, or anything else. It's an issue of patient safety.

Kevin McHugh