sedation

Using the sedative Remimazolam for oral surgery

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An interesting article titled “Can Remimazolam Be a New Sedative Option for Outpatients Undergoing Ambulatory Oral and Maxillofacial Surgery?” appears in the Journal of Oral and Maxillofacial Surgery written by Zijian Guo and et. al. (Available online 16 September 2022). The article discusses the sedative remimazolam and its possibility to sedate in oral surgery as effectively as midazolam. In the article the authors discuss how patients can receive dental treatment with more comfort using sedation. Midazolam is widely used in oral and maxillofacial surgery but has side effects of increased accumulation and respiratory depression. Remimazolam has similar pharmacological effects to midazolam but has rapid onset, fast metabolism, less potential adverse effects. Remimazolam has a a mean half-life of between 0.5 and two minutes and a terminal half-life in plasma of 37 to 53 minutes.  The authors conducted the first ever … Read more

Hallucinations While Taking Anesthesia: Implications for Sexual Assault

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In the past it has been discussed how in rare occasions patients (mostly young women) while having wisdom teeth surgery are sexually assaulted. This is discussed at http://www.teethremoval.com/sexual_assault_under_anesthesia_for_wisdom_teeth_removal.html and in several blog posts such as In Light of the Allegations of Child Sex Abuse at Penn State…, Dentist Who Groped Patients Sentenced to Jail, and Recent Cases of Dentist Assistant Sexual Assault During Wisdom Teeth Removal. Many times these patients go on to sue either the dental assistance or dentist or oral surgeon who committed the sexual assault. However, most of these same patients are given drugs during the surgery that can cause sexual hallucinations. Thus it is typical for the legal team defending the dental assistance or dentist or oral surgeon to argue that the patient was dreaming and no actual sexual assault occurred. In some cases it is … Read more

Is it Safe for Children to Receive Sedation/Anesthesia from an Oral Surgeon or Dentist using a Single Provider/Operator Model?

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Recently on this site there has been much discussion on updated guidelines put out by various groups that argue that children having deep sedation and anesthesia are not safely being served by dentists and oral surgeons using a single provider/operator model. Instead these guidelines call for a multi-provider model where the person doing the dental work or oral surgery and the person administering and monitoring the sedation/anesthesia are two separate individuals. See the posts AAOMS Pushes Back on Anesthesia Guidelines for Pediatric Patients and Updated Sedation Guidelines in Dentistry for Children for additional details. Some of the individuals leading the charge against the current anesthesia delivery model for children have published a new opinion piece titled “The Single-Clinician–Operator/Anesthetist Model for Dental Deep Sedation/Anesthesia: A Major Safety Issue for Children” published online in JAMA Pediatrics on Oct. 28, 2019 (written by … Read more

AAOMS Pushes Back on Anesthesia Guidelines for Pediatric Patients

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Earlier this year in 2019, the American Society of Anesthesiologists (ASA), the Society for Pediatric Anesthesia (SPA), the American Society of Dentist Anesthesiologists (ASDA), the Society for Pediatric Sedation (SPS), the American Academy of Pediatric Dentistry (AAPD), and the American Academy of Pediatrics (AAP) put out updated guidelines regarding the use of deep sedation and general anesthesia for children at a dental facility. The ASA, SPA, ASDA, and SPS put out a separate distinct set of guidelines from the AAPD/AAP. These guidelines are available from https://www.asahq.org/advocacy-and-asapac/advocacy-topics/office-based-anesthesia-and-dental-anesthesia/joint-statement-pediatric-dental-sedation and the June 2019 edition of Pediatrics in an article titled “Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures” written by Coté and Wilson, which was previously discussed in the blog post Updated Sedation Guidelines in Dentistry for Children. The guidelines are slightly different but the … Read more

Oral and Maxillofacial Surgeons Using Simulation to Improve Preparedness for Adverse Events with Sedation and Anesthesia

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According to the July/August 2019 edition of AAOMS today (vol. 17, no 4) the American Association of Oral and Maxillofacial Surgeons (AAOMS) has launched a new National Simulation Program allowing for members and staff to practice techniques on manikins. This can allow for better preparedness by receiving feedback on areas that may require additional training. The same simulated events are given to all participants which allows for objective assessments. The courses can offer instant feedback and point out any deficiencies by the surgeon. The goal of such simulation is to improve patient outcomes. AAOMS currently offers simulation programs in Minnesota and South Carolina. A particular focus on the simulation is on training oral surgeons for preventing events that can be devastating such as a death or brain injury. Thus one focus of the simulation is on Basic Emergency Airway Management … Read more