The American Association of Oral and Maxillofacial Surgeons Simulation Program.

Patient safety in dental anesthesia has been called into question in recent years. Simulation training has been proposed and developed as one possibility for increasing preparedness and training in cases of adverse events in dental anesthesia. This article presents an overview of the challenges of patient safety in dental anesthesia and how to address them with simulation training. The American Association of Oral and Maxillofacial Surgeons simulation program is unique in its potential to become a standardized, validated competency course with objective grading criteria, mastery-based cooperative learning model, and low facilitator-to-participant ratio, leading to a practical delivery cost structure.

General Concepts of Patient Safety for the Oral and Maxillofacial Surgeon.

Whether managing patients in private offices or as part of a care team at hospitals, oral and maxillofacial surgeons owe it to patients to understand medical error and take action to reduce its frequency and adverse effects. This article reviews general concepts of patient safety, including high-reliability organization, crew resource management, simulation training, root cause analysis, and just culture.

Simulation Training for the Office-Based Anesthesia Team.

An OMS office is a complex environment. Within such an environment, a diverse scope of complex surgical procedures is performed with different levels of anesthesia, ranging from local anesthesia to general anesthesia, on patients with varying comorbidities. Optimal patient outcomes require a functional surgical and anesthetic team, who are familiar with both standard operational principles and emergency recognition and management. Offices with high volume and time pressure add further stress and potential risk to the office environment. Creating and maintaining a functional surgical and anesthetic team that is competent with a culture of patient safety and risk reduction is a significant challenge that requires time, commitment, planning, and dedication. This article focuses on the role of simulation training in office training and preparation.

Pediatric sedation and anesthesia for the oral surgeon.

Even simple oral and maxillofacial surgical procedures can become challenging when the child patient has a high degree of fear and anxiety. This article reviews differences in anatomy and physiology between the adult and pediatric patient, preanesthetic assessment, fasting guidelines, and choices of sedation routes, and discusses equipment options for the management of pediatric anesthesia. After reflection on these topics and based on training and experience, oral and maxillofacial surgeons can decide the ages of patients, medical comorbidities, and techniques with which they are comfortable in performing surgery in their offices in a safe and effective manner.

Anesthetic considerations for the obese and morbidly obese oral and maxillofacial surgery patient.

The purpose of this article is to review the problems of anesthetic management of the obese patient and review current literature on this topic. Obesity is associated with a wide spectrum of medical problems. Anesthetic management requires being familiar with the pathophysiologic changes associated with obesity as well as the specific management issues that can arise. We will review recommendations from the literature on anesthesia management as they apply to the oral and maxillofacial surgeon.

A comparison of endotracheal intubation and use of the laryngeal mask airway for ambulatory oral surgery patients.

PURPOSE: This study compared current experience with the laryngeal mask airway (LMA) to previous experience with endotracheal intubation for ambulatory patients receiving general anesthesia. PATIENTS AND METHODS: A retrospective comparison of 157 patients (50 endotracheal intubation [ET] and 107 LMA cases) was conducted. The subjects were American Association of Anesthesiologist (ASA) Class I and II patients who underwent outpatient general anesthesia for dentoalveolar surgery. Procedure time, recovery time, and cost of techniques were compared. RESULTS: The patients undergoing a variety of outpatient dentoalveolar surgical procedures under general anesthesia in the LMA group had a shorter procedure time than the ET group (40 vs 44 minutes) and had a significantly shorter recovery time (54 vs 67 minutes). In addition, compared with the cost of delivering care with ET, the LMA provided slightly lower cost per case ($20 to $30 per case compared with $35 to $80 per case), depending on the anesthetic technique used. Comparing the 2 techniques for removal of 4 impacted third molars (25 patients ET and 68 patients LMA) revealed a similar procedure time of 39 minutes for both groups, but a shorter recovery time for the LMA group (54 vs 68 minutes). CONCLUSIONS: Use of the LMA has advantages over endotracheal intubation for outpatients receiving general anesthesia for dentoalveolar surgery.