Proceedings of the Third American Association of Oral and Maxillofacial Surgeons Anesthesia Patient Safety Conference.

The 3rd Anesthesia Patient Safety Conference of the American Association of Oral and Maxillofacial Surgeons was held at the Daniel M Laskin Institute for Oral and Maxillofacial Surgery Education and Innovation at American Association of Oral and Maxillofacial Surgeons headquarters in Rosemont, Illinois on June 6, 2022. The conference provided a platform to scrutinize collective errors, explore optimal practices, comprehend the concepts and principles of human complacency, assessing the system's capacity to handle deviations from the norm, and contemplate ideas and initiatives to enhance our practice model. These safety conferences are designed to foster collaborative, proactive conversations and understand best practices in safe delivery of anesthetic care to our patients.

ACE-Inhibitor or ARB-Induced Refractory Hypotension Treated With Vasopressin in Patients Undergoing General Anesthesia for Dentistry: Two Case Reports.

Two case reports present the use of vasopressin for treating refractory hypotension associated with continued angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to general anesthesia for oral surgery. Both patients were treated in an ambulatory dental surgery clinic and took either their ACEI or ARB medication for hypertension within 24 hours prior to undergoing an intubated general anesthetic. Persistent profound hypotension was encountered intraoperatively that was refractory to treatment with traditional methods. However, the ACEI- or ARB-induced refractory hypotension was successfully managed with the administration of vasopressin.

Evaluation and Management of Impacted Teeth in the Adolescent Patient.

The most common oral and maxillofacial surgical procedure in adolescents is excision of impacted third molars. Adolescent patients should be evaluated for third molars starting around age 16 years unless symptomatic at an earlier age. The dental examination should include panorex imaging to assess development, pathologic condition, and possibility of eruption versus impaction. Various classification systems are available to identify the position and difficulty of the proposed surgical procedure. Retained impacted teeth increase the patient's risk of various morbidities including recurrent infection, damage to adjacent teeth, cysts and other lesions, and unexplained pain.

Cardiovascular anesthetic complications and treatment in oral surgery.

Perioperative hypertension is a common problem. If hypertension is left untreated in patients at risk, infarctions and stroke are possible. There are limited choices of antihypertensive agents for the office. Aggressive antihypertensive therapy is not indicated because most of the episodes seen in the office are hypertensive urgencies and not emergencies. Hypotension is usually managed by decreasing the depth of anesthesia, intravenous fluids, and then vasopressors, typically ephedrine or phenylephrine. Consider treatment of hypotension whenever the mean arterial pressure decreases less than 60 mm Hg.