Anesthesia Complications in the Dental Office

Anesthetic complications, which range from simple annoyances topatient mortality, are inevitable, given the many and complexinteractions of doctor, patient, personnel, and facility.Anesthesia Complications in the Dental Office helps dentistsminimize the frequency and severity of adverse events by providingconcise and clinically relevant information that can be put toeveryday use. Anesthesia Complications in the Dental Office presents themost up-to-date information on treating anesthesia complicationsand medical emergencies. Drs. Bosack and Lieblich and a team ofexpert contributors discuss patient risk assessment; considerationsfor special needs and medically compromised patients; routinelyadministered anesthetic agents; adversities that can arise before,during, and after administration of anesthesia; and emergency drugsand equipment. A must-have reference for every dental office. >CONTENTS

Section 1: Introduction

1 Anesthetic complications—how bad things happen 3
Robert C. Bosack

Section 2: Patient risk assessment

2 History and physical evaluation 9
Kyle Kramer, Trevor Treasure, Charles Kates, Carrie Klene and Jeffrey Bennett

3 Laboratory evaluation 15
Kyle Kramer and Jeffrey Bennett

4 NPO guidelines 19
Kyle Kramer and Jeffrey Bennett

Section 3: Anesthetic considerations for special patients

5 Anesthetic considerations for patients with cardiovascular disease 25
Erik Anderson and Robert Bosack

6 Anesthetic considerations for patients with respiratory disease 49
Robert C. Bosack and Zak Messieha

7 Anesthetic considerations for patients with endocrinopathies 61
Daniel Sarasin Kevin McCann and Robert Bosack

8 Anesthetic considerations for patients with psychiatric illness 71
Daniel L. Orr, Robert C. Bosack and John Meiszner

9 Anesthetic considerations for patients with neurologic disease 79
Joseph A. Giovannitti

10 Anesthetic considerations for patients with hepatic disease 85
Jeffrey Miller and Stuart Lieblich

11 Anesthetic considerations for patients with renal disease 89
Marci H. Levine and Andrea Schreiber

12 Anesthetic considerations for pediatric patients 93
Michael Rollert and Morton Rosenberg

13 Anesthetic considerations for geriatric patients 97
Andrea Schreiber and Peter M. Tan

14 Anesthetic considerations for patients with bleeding disorders 103
O. Ross Beirne

15 Anesthetic considerations for patients with cancer 113
Andrea M. Fonner and Robert C. Bosack

16 Anesthetic considerations for pregnant and early postpartum patients 117
Robert C. Bosack

Section 4: Review of anesthetic agents

17 Clinical principles of anesthetic pharmacology 123
Richard C. Robert

18 Local anesthetic pharmacology 129
Roy L. Stevens and Robert C. Bosack

19 Enteral sedation agents 133
Richard C. Robert

20 Parenteral anesthetic agents 135
Richard C. Robert

21 Inhalational anesthetic agents 143
Charles Kates, Douglas Anderson, Richard Shamo and Robert Bosack

22 Antimuscarinics and antihistamines 151
Richard C. Robert

23 Drug interactions 155
Kyle Kramer and Richard C. Robert

Section 5: Monitoring

24 Limitations of patient monitoring during office-based anesthesia 163
Robert C. Bosack and Ken Lee

Section 6: Preparation for adversity

25 Crisis resource management 173
Joseph Kras

26 Simulation in dental anesthesia 177
Joseph Kras

27 Airway adjuncts 181
H.William Gottschalk

28 Intravenous fluids 185
Cara Riley, Kyle Kramer and Jeffrey Bennett

29 Emergency drugs 189
Daniel A. Haas

Section 7: Anesthetic adversity

30 Failed sedation 201
Roy L. Stevens and Kenneth L. Reed

31 Complications with the use of local anesthetics 207
M. Anthony Pogrel, Roy L. Stevens, Robert C. Bosack and Timothy Orr

32 Anesthetic adversity – cardiovascular problems 219
Robert C. Bosack and Edward C. Adlesic

33 Anesthetic adversity—respiratory problems 231
Charles F. Cangemi, Edward C. Adlesic and Robert C. Bosack

34 Allergy and anaphylaxis 251
H.William Gottschalk and Robert C. Bosack

35 Anesthetic adversity–neurologic problems 257
Michael Trofa and Robert C. Bosack

36 Acute adverse cognitive behavioral and neuromuscular changes 261
Edward Adlesic, Douglas Anderson, Robert Bosack, Daniel L. Orr and Steven Ganzberg

37 Anesthetic problems involving vasculature 271
Stuart Lieblich

Section 8: Post-anesthetic adversity

38 Nausea and vomiting 277
Edward Adlesic

39 Post-anesthetic recall of intraoperative awareness 283
Robert C. Bosack

40 Delayed awakening from anesthesia 287
Stuart E. Lieblich

41 Safe discharge after office-based anesthesia 291
Stuart Lieblich and Peter M. Tan

Section 9: When bad things happen

42 Morbidity and mortality 295
Lewis Estabrooks

43 Death in the chair: a dentist’s nightmare 299
Glen Crick

44 Legal issues of anesthesia complications: risks or malpractice 307
Arthur W. Curley

Section 10: When should you say no

45 When should you say no? 315
Andrew Herlich and Robert C. Bosack

Section 11: Appendices

Appendix A A pilot’s perspective on crisis resource management 323
David Yock

Appendix B Medical emergency manual for the general practitioner 325
Robert C. Bosack

Appendix C Malignant hyperthermia Q & A 337
Edward C. Adlesic and Steven I. Ganzberg

Index 339

Robert C. Bosack, DDS, is an oral and maxillofacial surgeon and clinical assistant professor at the University of Illinois College of Dentistry. He has served as an examiner for the American Board of Oral and Maxillofacial Surgery, and has served on the board of directors of the National Dental Board of Anesthesiology. He is the executive director of Dental Anesthesia Online. Dr. Bosack speaks at national dental and anesthesia conferences and has written professional articles and the book Medical Emergencies in the Dental Office. He maintains a private practice in Orland Park, Illinois. Stuart Lieblich, DMD, is clinical professor in the Division of Oral and Maxillofacial Surgery at the University of Connecticut School of Dental Medicine. He is a Past President of the American Dental Society of Anesthesiology and a past Director of the American Board of Oral and Maxillofacial Surgery. He serves on the editorial board of 3 major journals, has written more than 20 textbook chapters, and is an invited speaker at national conferences. Dr. Lieblich maintains a private practice in Avon, Connecticut.