Dr. Patrick Brain
Oral & Maxillofacial Surgeon
Lone Peak Oral Surgery & Implant Center
"After completing dental school, our young family moved to Ann Arbor, Michigan where I completed a four-year surgical residency. In addition to performing hundreds of surgical cases, I spent 6 months on rotation with the Department of Anesthesia, administering anesthesia in the main OR and children’s hospital. These six months, combined with two months in the Trauma and Burn ICU, and one month each in the Neurosurgical ICU and Surgical ICU, provided invaluable experience managing medically complex, sick patients." Dr. Patrick Brain
1. Are you licensed to provide IV sedation/moderate sedation Operating Room general anesthesia/deep sedation?
A general dentist can become certified to administer IV sedation, or moderate sedation in the State of Utah (class 3 license). An oral surgeon can provide general anesthesia, or deep sedation in Utah (class 4 license). IV sedation should not and is not intended to cause total loss of consciousness. It is often described as “twilight sleep” and helps reduce stress and anxiety. For many, it is capable of providing a perfect level of calm. However, anxiety and stress seem capable of reaching unusually high levels when faced with an oral surgery procedure. A patient planning to “be completely out” will require general anesthesia (class IV anesthesia). Unlike IV sedation, general anesthesia causes total loss of consciousness and greater muscular relaxation. Benevolent claims by an IV sedation dentist suggesting “comfort and safety” improve by adding an additional anesthesia provider, aren’t accurate. Aside from an absence of scientific literature supporting such claims, an IV sedation dentist, whose patient expects total loss of consciousness, CANNOT legally perform general anesthesia and therefore, by law, is mandated to have a second person.
2. What was the extent, length of time, environment (hospital-based v. classroom or online) of your anesthesia training?
What was the extent, length of time, environment (hospital-based v. classroom or online) of your anesthesia training? Oral surgeons spend 4-6 years in a hospital-based residency AFTER four years of dental school. A major part of residency focuses on anesthesia training. A 6-month rotation dedicated to anesthesia training takes place in operating rooms treating both adult and pediatric patients. In addition, oral surgery residents rotate through several ICUs, the emergency department, and medicine clinics, further exposing them to complex patient care and anesthesia training. These accredited programs qualify oral surgeons to perform general anesthesia, providing a combined total of approximately 18-24 total months of anesthesia experience. In addition, a hospital-based residency exposes one to a spectrum of sick and compromised patients, furthering the experience through managing complex conditions. While some dental schools expose students to IV sedation, they do not certify them. Dentists wanting to incorporate IV sedation into their practices must participate in private training courses after dental school. Courses are offered nationwide, commonly certifying participants in as few as 6 days.
3. Is your facility/office equipped with emergency medications, emergency equipment (especially airway devices), emergency oxygen, and are the items current, up-to-date, and inspected?
Oral surgeons are required to complete mandatory Office Anesthesia Evaluations (OAE) every 5 years consisting of four parts. These include an evaluation of the facilities, stock of emergency medications, emergency equipment, hands-on demonstration by the oral surgeon and his/her team of the management of simulated office emergencies, and observation of actual patient anesthesia/surgeries in the office. Oversight is not mandated by state or local agencies over dentists and dental offices performing IV sedation.
4. Is your staff trained to handle emergencies; CPR certified, anesthesia certified, and do receive training to manage emergency situations?
Is your staff trained to handle emergencies; CPR certified, anesthesia certified, and do receive training to manage emergency situations? Oral surgery and the anesthesia team model continue to focus on safety through programs like DAANCE, the Dental Anesthesia Assistants National Certification Exam and other similar programs. The American Association of Oral and Maxillofacial Surgeons, the national association, and the Utah Association of Oral and Maxillofacial Surgeons, the state association, offers many resources for staff development including: Anesthesia Review for Dental Anesthesia Assistants, Advanced Protocols for Medical Emergencies in the Oral Surgery Office, Anesthesia Assistants Review Courses, Simulation Training Programs, and the Anesthesia Assistants Skills Lab. Scientific studies that have looked at complications in oral surgery offices continue to reveal enviable safety records, comparing favorably with hospital based care.
5. Have YOU had to manage anesthetic emergencies?
This can be an uncomfortable question to ask but when you or a loved one is receiving anesthesia, confidence that the provider, their staff, and facility are capable and well trained is critical. Nobody wants to admit having complications or deal with emergency situations. Johann Wolfgang von Goethe wrote, “Knowing is not enough; we must apply. Willing is not enough; we must do.” Fortunately, complications are rare but the reality exists that they can and do occur. In an emergent situation, knowing what to do or having a willingness to act aren’t sufficient. Reading a manual explaining how to land an airplane won’t ever compare to actually doing so. Residency and a wealth of anesthesia experiences provides many opportunities to “apply” and “do.”
Office-based anesthesia has been part of the training, practice, and history of oral and maxillofacial surgery for over 90 years. In 1930, when Dr. John Lundy established the anesthesia residency program at the Mayo Clinic, he developed and taught administration of IV pentothal to the Chief of Oral Surgery, Dr. Ed Staffney. This technique, initially taught to Mayo residents, now serves as a fundamental aspect of training for oral surgery residency everywhere. Hallmarked by ongoing innovation and safety, the longstanding tradition is respected, supported, and endorsed by American Society of Anesthesiologists. In 2004, Roger W. Litwiller MD, President of the American Society of Anesthesiologists reviewed and concurred with AAOMS’s “Parameters of Care for Anesthesia and Outpatient Facilities,” the official document defining clinical practice guidelines in anesthesia. His statement regarding the use of the general anesthetic, Propofol, and its use by oral surgeons resulted from, “…a long history of safely using general anesthesia in the care of their patients…”
As you consider your treatment and anesthetic options, we invite you to schedule a consultation so Dr. Brain and his staff can answer additional questions and help you feel more comfortable and confident about your surgical and anesthetic care.