William G Flick DDS, MPH Clinical Associate Professor University of Illinois Chicago Oral Maxillofacial Surgery Public Health Implications of the Illinois Dental Anesthesia and Sedation Survey for 2006 Sponsored by the Illinois Dental Society of Anesthesiology, and the Illinois Society of Oral Maxillofacial Surgeons
Dental Anesthesia and Sedation The Lighting Rod for Public Attention !
Probably the single most scrutinized area of dental practice
Adverse outcomes create a disproportionate amount of media attention
Public concern regarding the, appropriateness, regulation and even the necessity of such services.
ER and discharged Patient developed atypical tachycardia Arrhythmia ER discharged without complications Unstable blood pressure, hpotensive and hypertensive. Bood Pressure ER, discharged without complications 48 y/o had vasovagal reaction, 15 minutes after completion of procedure Prolonged Recovery ER for management Sustained seizure activity, did not respond to anti-convulsives. Previous history of epilepsy and had therapeutic levels of anti-seizure meds. Seizures ER, monitored and discharged Slow recovery from I.V. sedation Prolonged Recovery ER, tooth retrieved with endoscopy Aspiration of tooth crown under sedation Aspiration Object ER , discharged without complications. 45y/o developed post op chest pain Chest Pain ER, discharged, no cardiac dysfunction was uncovered. Patient had multiple dental extractions under general anesthesia. Slow recovery. Pulse dropped from 80 to 12 to 7. Treated with atropine. Prolonged Recovery ER, hospitalized for three days, patient developed mild stroke 62y/o undisclosed labile hypertension, non-compliant with medications. Under IV sedation developed unstable hypertension Blood Pressure ER transfer, pacemaker inserted one month later General anesthesia for multiple dental extractions. Patient complained of chest pain and feeling faint. EkG revealed atrial fibrillation Arrhythmia ER transfer. MI diagnosis, died five days later. Patient had full mouth extractions under general anesthesia. Patient stopped breathing 50 minutes into procedure. Patient intubated Myocardial Infarction ER transfer, died 50 y/o suffered MI on way to post anesthesia recovery following multiple dental extractions under general anesthesia. Never regained consciousness, patient had a non-disclosed history of MI at age 48 with sever cardiac muscle damage. Myocardial Infarction OUTCOME SCENARIO EVENT Emergency Event Summary
ER, antibiotics 45 y/o aspiration of vomitus post op Aspiration Vomitus ER, hospital to manage airway edema Laryngospasm, intubated in office Airway Management ER, monitored and discharged Asthma during anesthesia Airway Management ER, monitored and discharged Seizures under IV sedation Seizures ER, monitored and discharged Undisclosed cocaine us, dropped BP Drug Abuse ER, monitored and discharged Ventricular arrhythmia Arrhythmia ER, monitored and discharged Arrived and discharged with new onset atrial fibrillation Arrhythmia ER, diagnosed as pinched intercostal nerve 26 y/o chest pain following IV sedation Chest Pain ER, monitored and discharged Apnea, airway loss, unable to ventilate, intubated in office Airway Management ER, gauze retrieved 4x4 gauze loged in airway under IV sedation Aspiration Object ER, monitored and discharged Allergic reaction to Brevital Allegric Reaction
ER, hospital two days 40 y/o diabetic vomited under general anesthesia, aspirated. Aspiration Vomitus ER, thought to be related to h/o psychiatric problems Unresponsive post-op, normal breathing, stable vital signs Prolonged Recovery ER, monitored and discharged Hypeertensive episode Blood Pressure ER, hospital, mangement of bronchospasm 19 y/o undisclosed drug abuse, laryngospasm, intubated, excessive secretions Airway Management ER, monitored and discharged, non-cardiac 30 y/o post-op chest pain Chest Pain ER, monitored and discharged Delirium, hypertension post-op, no intraoperative hypertension, resolved with narcan Prolonged Recovery ER, monitored and discharged, non-cardiac Post-op chest pain Chest Pain ER, monitored and discharged, non-cardiac Post-op chest pain Chest Pain ER, monitored and discharged, non-cardiac Post-op chest pain Chest Pain ER, monitored and discharged Slow recovery from versed Prolonged Recovery ER, monitored and discharged 18 y/o developed tachycardia under sedation Arrhythmia