1. Oral and Maxillofacial Surgeons: Providing Safe, Effective Anesthesia Services in the Ambulatory Setting

2. OMS Anesthesia Services in the Ambulatory Setting Table of Contents What are the Levels of Sedation? OMSs are Well Qualified to Administer All Levels of Anesthesia/SedationOMSs are Well Qualified to Administer All Levels of Anesthesia/Sedation OMSs are Competent in Administering/Monitoring Anesthesia OMS Education & Training State Regulations Parameters of Care Enviable Record of Safety Practicing OMSs Continue to Hone Their Skills AAOMS Office Anesthesia Evaluation Program Prospective Outcome Study Supports OMS Anesthesia Administration Support for OMS Anesthesia Administration Oral and Maxillofacial Anesthesia Assistants Program (OMA... OMS Anesthesia Assistant Training

3. OMS Anesthesia Services in the Ambulatory Setting What are the Levels of Sedation? Local Anesthesia (LA): Local, or regional, anesthesia involves the injection or application of an anesthetic drug to a specific area of the body. It eliminates sensation and pain in a local area of the body without loss of consciousness. Non-Intravenous Conscious Sedation (CS): Non-Intravenous Conscious Sedation includes the administration of sedative and/or analgesic agent(s) by a route other than IV. These routes may involve (PO, PR, Intranasal, IM) and include appropriate monitoring. Conscious sedation medically controls a state of depressed consciousness while maintaining the patient’s airway, protective reflexes and the ability to respond to stimulation or verbal commands. Patients retain the ability to breathe on their own and can respond to physical or verbal stimulation. Return to Table of Contents

4. OMS Anesthesia Services in the Ambulatory Setting What are the Levels of Sedation? Intravenous Sedation/Analgesia A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective reflexes and the ability to respond to stimulation or verbal commands. It includes intravenous administration of sedative and/or analgesic agent(s) and appropriate monitoring. DeepSedation/General Anesthesia (DS/GA): An induced state of unconsciousness, accompanied by partial or complete loss of protective reflexes, including the ability to independently maintain the airway and respond purposefully to physical stimulation or verbal command. Return to Table of Contents

5. OMS Anesthesia Services in the Ambulatory Setting OMSs are Well Qualified to Administer All Levels of Anesthesia/Sedation OMSs have the ability to provide safe, effective anesthesia to patients in outpatient facilities. They are thoroughly trained and competent to: Diagnose and treat the source of pain and anxiety within the scope of their discipline; and Use appropriate techniques of local (regional) anesthesia, conscious sedation and deep sedation/general anesthesia.. Return to Table of Contents

6. OMS Anesthesia Services in the Ambulatory Setting OMSs are competent in: Airway management; Endotracheal intubation; Establishing and maintaining intravenous and arterial lines, and invasive monitors; Managing complications and emergencies associated with the administration of anesthesia. Return to Table of Contents

7. OMS Anesthesia Services in the Ambulatory Setting OMS Education & Training 4 + years post-doctoral, hospital- based surgical residency training alongside medical and surgical residents, including general surgery, anesthesia and others. At least 4 months on an anesthesia service rotation at the anesthesia resident’s level of competence. Ongoing experience throughout the residency in administration of CS and DS/GS to pediatric & adult patients. Training must include appropriate patient monitoring modalities and certification in Advanced Cardiac Life Support. Return to Table of Contents

8. OMS Anesthesia Services in the Ambulatory Setting State Regulations Regulations on the administration of sedation versus anesthesia in dental offices vary among states. In general, state regulations require: Anesthesia, whether office-based or in a hospital, should be performed by doctors based on their education and training. Appropriate training and continuing medical education should be documented and readily available to patients and the Boards of medicine or dentistry. Nearly all states require dentists/OMSs to procure a permit to administer anesthesia based on documented education, training and competence. Many states also require accreditation of outpatient surgical facilities. Return to Table of Contents

9. OMS Anesthesia Services in the Ambulatory Setting Parameters of Care Clinical Practice Guidelines for Oral and Maxillofacial Surgery General criteria, standards and considerations anesthesia in outpatient settings. Includes: Documentation of objective findings, diagnoses and patient management interventions. Evaluation of the OMS office, completion of ACLS course and equipped to meet ACLS standards Preanesthetic patient evaluation and assessment Equipment and drugs to address anesthesia-related complications and emergencies General anesthesia therapeutic goals for outpatient facilities General factors affecting risk during outpatient anesthesia General favorable therapeutic outcomes for outpatient anesthesia General known risks and complications Specific considerations for LA, CS, DS/GA, pregnant patient, pediatric patient Return to Table of Contents

10. OMS Anesthesia Services in the Ambulatory Setting Enviable Record of Safety Total number of office anesthetics 1988 - 2004 = 29,608,316 Statistics provided by: OMS National Insurance Co. Return to Table of Contents

11. OMS Anesthesia Services in the Ambulatory Setting Incidence of in-office anesthesia deaths/brain damage 1 704,960 Enviable Record of Safety Statistics provided by: OMS National Insurance Co. Return to Table of Contents

12. OMS Anesthesia Services in the Ambulatory Setting Practicing OMSs Continue to Hone Their Skills Practicing OMSs must comply with the rules and regulations of the states in which they are licensed and practice. OMSs must comply with the AAOMS Office Anesthesia Evaluation Program to retain membership in their state societies. Office anesthesia evaluation and re-evaluation must be completed every 5 years. AAOMS recommends the following indicators be monitored continuously or at regular intervals during sedation and general anesthetic procedures: Blood pressure; Heart rate and rhythm (ECG); and Monitoring oxygenation by continuous use of pulse oximetry. Monitoring ventilation by auscultation of breath sounds or other methods Return to Table of Contents

13. OMS Anesthesia Services in the Ambulatory Setting AAOMS Office Anesthesia Evaluation Program Program requires on-site office anesthesia evaluation and reevaluation every 5 years, including: Evaluation of Office facility, drugs, equipment and records Simulation of response to emergencies by the anesthesia team. Observation of Office Anesthesia and Surgical Procedure, where possible. Discussion Period. Requirements often exceed those mandated by state law. Return to Table of Contents

14. OMS Anesthesia Services in the Ambulatory Setting Prospective Outcome Study Supports OMS Anesthesia Administration & Patient Satisfaction The sample was composed of 34,191 patients, of whom 71.9% received DS/GA, 15.5% received CS, 12.6% received LA. Before Procedure - 80.3% reported some degree of anxiety. After Procedure - 61.2% reported having no anxiety about future operations. Overall, 94.3% of patients reported satisfaction with the anesthetic, and More than 94.7% of all patients would recommend the anesthetic technique to a loved one. Perrott, DH, et al, Office-Based Ambulatory Anesthesia: Outcomes of Clinical Practice of Oral and Maxillofacial Surgeons, J Oral Maxillofac Surg, 2003 61:983-995, Return to Table of Contents

15. OMS Anesthesia Services in the Ambulatory Setting Support for OMS Anesthesia Administration Return to Table of Contents

16. OMS Anesthesia Services in the Ambulatory Setting Oral and Maxillofacial Anesthesia Assistants Program (OMAAP) OMAAP - a two-part continuing education program designed for OMS assistants or assistants employed by a dentist with a valid anesthesia permit. Study materials and a reading list A practice test follows each module. At the conclusion of the coursework, a comprehensive examination. Those who successfully complete the exam receive a certificate of completion and a lapel pin. Return to Table of Contents

17. OMS Anesthesia Services in the Ambulatory Setting OMS Anesthesia Assistant Training AAOMS Anesthesia Assistants Review Course A continuing education course to improve the anesthesia knowledge and skills of OMS clinical staff who have completed the OMAAP program. Two-day program focuses on: Principles of anesthesia Latest innovations Basic sciences Patient evaluation and preparation Anesthetic drugs and techniques Patient Monitoring Emergency procedures Return to Table of Contents