Vital Times 2017 - 32

CSA President Karen Sibert, MD, FASA, on NBC News

oral surgeon's office to have her wisdom teeth removed,
and died of hypoxic injury following bradycardia and
cardiac arrest. In Florida, 17-year-old Christopher Power
died last year after he received meperidine and midazolam
for wisdom tooth extraction from a dentist with "sedation
training."
Unfortunately, mishaps can occur in the recovery period
as well as during the procedure. Few dental offices are
equipped with qualified PACU nurses, or set rigorous
recovery and discharge criteria. I've reviewed a case of
wisdom tooth extraction where a teenager was monitored
for a grand total of seven minutes after general anesthesia
- which included ketamine, fentanyl, and 10 mg of IV
midazolam - before being packed into the back seat of his
mother's car. He promptly turned blue, but his mother
managed to get him to a nearby emergency room in time to
be resuscitated.
No matter how tightly anyone tries to craft a law, the dentists
and oral surgeons will try to figure out a way around it. The
latest gambit is their definition of "deep sedation with local

32 		|	 	 CSA	Vital	Times

anesthesia" as a type of anesthesia unique to oral surgery
that doesn't require a separate anesthesia professional in
attendance. I wish I were joking; that term was used in a
presentation by Tenerfe Tejera, DMD, MD to the American
Association of Dental Boards in October 2017.
In Dr. Tejera's exact words, the oral and maxillofacial
surgeons (OMS) "are drawing the clear distinction between
deep sedation with local anesthesia and general anesthesia
in advocating for the OMS anesthesia team model." That's
the team model, I would remind you, that allows a dental
assistant with a high school education to monitor the
patient's vital signs and keep the dentist informed as to how
the patient is faring.
But wait, you say. Even CMS considers deep sedation and
general anesthesia to be so close in terms of risk and scope
that they have identical monitoring requirements, and are
billed and paid for in the same way. The oral surgeons don't
care.



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