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James A. Snyder, DDS, MS
Office-Based Anesthesia: What Patients Should Know
In the following excerpt from a newsletter of the Society for Office-Based Anesthesia (SOBA), Dr. James Snyder outlines some important information for patients who are considering dental sedation and office-based anesthesia (OBA). If you'd like to schedule an appointment with Dr. Snyder and his team of sedation dentists, please contact our Alexandria practice, serving Washington, D.C., and the surrounding region.
Communicating with Patients about OBA: SOBA's Patient Assistance Sheet
James A. Snyder, DDS
The administration of advanced forms of anesthesia in an office setting is increasing rapidly. Office-based anesthesia (OBA) has been one of the results of a confluence of a number of medical and social movements. The Society for Office-Based Anesthesia (SOBA) formed to continuously improve the quality of anesthesia care and patient outcomes in the field of office-based surgery.
Patient questions generally fell into one of two categories. One group represented information on where to obtain adequate anesthesia for their planned office-based treatment and find an experienced sedation dentist or anesthesiologist. Clearly, the public at large needed and was demanding anesthesia services that could not be easily met in their community by a sedation dentist or anesthesiologist. Requests for anesthesia services for dental treatment were most common, but many medical fields were represented in their requests. Unfortunately, SOBA was unable to guide most patients to anesthesia providers like a sedation dentist or anesthesiologist with expertise in office-based anesthesia because few are available.
The other category of patients had found anesthesia services to match their treatment but was uncomfortable with some aspect of the anesthesia plan. The office setting affords the patient fewer resources for information gathering and verifying than an institution like a hospital. If patients are uncomfortable of unsatisfied with the information they are given by a sedation dentist or anesthesiologist in an office situation, they feel the need to seek outside sources for verification. Often the problem is visceral or emotional, not factual. For instance, patients sought guidance in deciphering whether "sedation" meant they would be "asleep" or whether "twilight sleep" was the same as sedation. Patients wondered, "Is it safe to be ‘put to sleep' in an office?" Some were concerned about what level of anesthesia would meet their needs for the given procedure.
These requests were occurring while the popular press, from Glamour to USAToday ran offerings on office-based surgery and anesthesia. Often these articles tried (usually in a very limited way) to provide consumer guidance in these areas. Such coverage, in conjunction with the disturbing news stories of office-based anesthesia and surgical deaths, led to the conclusion that OBA (and surgery) was a pretty hot topic.
Hoping to minimize the popularization that seems common to public issues these days, SOBA felt that patients/consumers could use some help from trained and experienced professionals in this area. It was thought that a simple series of questions with a little guidance about the meaning of the possible answers would be useful. The questions needed to encompass the various levels of consciousness offered to OBA patients and to be phrased in language most could understand. The questions should be neither leading nor threatening but result in information that seemed to meet the needs of most people. Being able to capitalize on the SOBA members' experience was a nice asset for a sedation dentist and anesthesiologist alike.
OBA is a reasonable solution for an increasing population of patients and set of procedures. It is not suitable for all patients and all procedures. Persons who are ‘reasonably healthy' are good candidates for OBA. A general guideline that one can give the lay public notes that, "If you keep a steady work schedule without frequent interruptions for visits to the doctor of hospital, you likely are ‘reasonably healthy'. Among the common exceptions: if you require special medications for surgery or have bleeding or breathing problems. Office-based procedures should be non-central. For instance, plastic surgery on faces or breasts is non-central, as is dental treatment." Final determination of the setting should be made on the basis of consultation between surgeon, anesthesia provider, sedation dentist, anesthesiologist, and patient.
Safety seems to be most closely related to the experience of the anesthesiologist and sedation dentist, regardless of the venue. OBA disasters are very rare when a qualified anesthesiologist / sedation dentist is present and dedicated solely to the anesthesia. Misadventures are also uncommon when conscious sedation is provided by the surgeon who employs a separate staff member to monitor the patient. This approach is limited to conscious sedation and relies on adequate training in sedation of the surgeon and monitoring individual.
Occasionally, these important decisions are made in a financial context. There is nothing wrong in being wise fiscally, but the trade should never be safety for dollars.
Including the patient in the decision process will help everyone involved - patient, surgeon, sedation dentist, and anesthesiologist. Our goal is comfort and safety for every patient. Safety and comfort usually leads to satisfaction. Satisfaction is the best possible outcome.
With these thoughts in mind, the consumer assistance sheet on the following page has been created. Readers may copy this form for use in their practice.
Contact Our Office to Schedule a Consultation with Our Experienced Sedation Dentist
Please contact the dental practice of Dr. James Snyder today to schedule a consultation with a dedicated and experienced sedation dentist and anesthesiologist serving Alexandria, Washington, D.C., Arlington, Virginia, and surrounding areas.