Message from the President:
June 2006
Safety: A Conscious Effort
Continuing education serves not only to fulfill requisite continuing
education requirements but also to serve as a forum in which we can
review outpatient anesthesia care service. Ongoing evaluation of
office based anesthesia by the board of dentistry also serves to
protect the public. The Board of Dentistry has in the past addressed
potential concerns over (oral) enteral sedation, clarified
definitions of various sedation modalities, and has instituted the
requirement of AED's for dental practices. Future revisions by the
Board may include restrictions of drug use pertaining to conscious
sedation. It would be wise to monitor any changes by visiting Recent
Anesthesia Rule Updates located at Florida's Department of Health
website. (http://www.doh.state.fl.us/mqa/dentistry).
Complying with the Board's anesthesia requirements in terms of
emergency drugs and equipment allows us to provide necessary
anesthesia care in a safe manner. There are a few additional
materials and drugs which I believe are worthy of inclusion into
your emergency crash cart. I believe an LMA, actually a few of
different sizes, is an important airway adjunct. Although ET tubes
and a laryngoscope are part of everyone’s emergency kit, the LMA may
provide an advantage in an emergency, most notably for the conscious
sedation group. The relative ease of placement of the LMA as
compared to the ET tube may save valuable time in establishing an
airway. Disposable, sterile, LMA's are available at reasonable cost.
Florida law requires medications for a variety of emergency
scenarios, including, but not limited to, hypertension, hypotension,
allergic reaction, anaphylaxis, myocardial infarction, and angina.
The list of medications that is required by law does not constitute
every drug on the ACLS protocol. As we are all required to be
current with ACLS, it may be prudent to carry those drugs involved
with the ACLS algorithms that are not mandated by law. For example,
narrow complex tachycardia, (PSVT) could be treated with
synchronized cardioversion or with drugs. (assuming you already
tried a vagal maneuver, unsuccessfully). We are required to carry
Amiodorone and Lidocaine. Amiodorone can be used for PSVT while
Lidocaine is indicated in wide complex tachycardia. Adenosine,
Calcium channel blockers or beta blockers may be worthy of your
consideration. Due care is required of course with any of the above
agents.
Also, we are required to carry D50 Dextrose for treatment of
hypoglycemia. Again, although not specifically required, it may be
helpful to obtain a glucose meter for inclusion in your emergency
kit. Similar arguments can be made for other drugs not mandated by
the board for inclusion in our emergency carts.
Lastly, mock emergency scenarios should be part of an office
training program. A review of urgencies and emergencies, with staff
involvement, provides an excellent complement to our collection of
emergency drugs and equipment. In-house training provides
opportunities to also conduct periodic testing of emergency
equipment. This may insure it's usefulness during a crisis.
An application as an AGD provider has been submitted. Dentist's who
belong to the AGD and wish to supplement their c.e. requirements may
do so in the future. AGD accreditation should ease the burden of
those dentists seeking fellowship status.
We look forward to next years scientific session; our presentation
will highlight Pediatric Sedation considerations.
The FDSA's annual business meeting will take place at the Gaylord
Palm's Resort this June 2006 on Saturday June 17, 2006. Exact date
and time will be announced and noticed on our website (www.fdsahome.org)
The FDSA wishes to represent all members with interests in
anesthesia and sedation. All interested in attending our annual
business meeting are welcome.
A listing of continuing education opportunities in anesthesia and
sedation are listed in this issue for your consideration.
Opportunities for all levels of training are available. Please
contact me, or the FDSA office, with any programs of interest you
may wish the organization to pursue.
The practice of dentistry and office based anesthesia are
privileges. I appreciate the opportunity to serve and feel
privileged to have worked with some of the finest people in
dentistry that are the FDSA. My sincerest thanks.
Kindest Regards,
Michael Gioia Jr. DMD
