What about anesthesia on patients with complex needs?

Sept. 11, 2004
The topic will be addressed during the AAOMS meeting in late September in San Francisco.

A morbidly obese man has corrective facial surgery to fix an overbite. A man in his forties with heart disease undergoes dental implant surgery to replace lost teeth. The biggest challenge facing the oral and maxillofacial surgeon isn't the surgery, it's the anesthesia.

With demographic changes and shifting disease patterns, OMSs have begun seeing unprecedented numbers of patients with complex anesthetic requirements and more different types of complex cases, says Jeffrey B. Dembo, DDS, professor of oral and maxillofacial surgery at the University of Kentucky in Lexington, who will address the delivery of anesthesia to patients with complex needs during the American Association of Oral and Maxillofacial Surgeons 86th annual meeting, September 29 through October 2, 2004, in San Francisco.

Delivering anesthesia to patients is integral to the work of OMSs, who undergo rigorous hospital-based anesthesia training to manage this aspect of patient care. "But the growing complexity of cases requires the use of increasingly sophisticated anesthetic techniques," says Dr. Dembo. "The nature of the surgical procedures we do hasn't changed all that much in the last century, and the drugs we use haven't changed much in last decade, but the patients have become more complex in terms of age, past medical and dental experiences and underlying systemic diseases."

Dr. Dembo cites the graying of America as a prime example of recent changes in the patient population. "People are living to be 100 and are keeping their teeth longer, so OMSs are treating more geriatric patients today than ever," he says. "Twenty years ago, you would rarely see a 70- or 80-year-old patient, because most people that age wouldn't have their teeth. Now, it's not uncommon for an OMS to have patients over the age of 100."

Older patients also have more chronic diseases -- conditions that increase the risk for anesthesia complications and require solid clinical skills to prevent those complications.

The ideal approach for managing intricate cases such as these from beginning to end is not always clear cut. For that reason, the symposium will engage OMSs in a debate of the pros and cons of various diagnostic and
treatment methods and help practitioners reach a consensus on the optimal anesthetic strategies.

A panel of experts will present four difficult cases: (1) an obese 38-year-old male, 5'5", 230 pounds; (2) a rambunctious pre-adolescent; (3) a patient with gastroesophageal reflux disease (GERD); and (4) a middle-aged patient with a history of hypertension and myocardial infarction (heart attack).

"OMSs have the knowledge and training to manage these risks, but these factors add significantly to a case's complexity," Dr. Dembo says. Because of their extensive hospital-based training in anesthesia, OMSs are also treating more pediatric patients when a procedure calls for sedation and anesthesia.

"Children are always a challenge as far as anesthesia goes," he notes. "Children exhibit changes more rapidly in respiration and blood pressure, so if something is going to be a problem, it will become a problem much more quickly than with an adult. There is less latitude and less time to intervene."

"In addition to taking a careful history, it's the OMS's job to refer the patient to the other providers that need to be seen before we can do surgery," adds Dr. Dembo.

The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 7,000 oral and maxillofacial surgeons in the United States, supports its members' ability to practice their specialty through education, research, and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.