- Email: [email protected]
Anesthetic Management of the Geriatric and Multiple System Compromised Patient
Symposia
Pulmonary Diseases Norman J. Betts, DDS, MS, Plymouth, MI
Non Cardiac Complications in Office Based Surgery John W. Robinson III, DMD, Asheville, NC
No abstract provided. No abstract provided.
Wednesday, September 17, 2008, 7:30 am–11:30 am
Are You Truly Ready for an Office Anesthetic Emergency? Richard C. Robert, DDS, MS, San Francisco, CA Arthur Curley, JD, Larkspur, CA In every oral and maxillofacial surgery office the care providers must be ready for a medical or anesthetic emergency that could happen on any day, at any time. However, when many new employees begin working in an oral and maxillofacial surgery office, they have limited medical background. Death or serious injury always turns a bright light on the oral surgery office, particularly when it involves delivering conscious sedation or general anesthesia. Claims of substandard care often focus on deficits in resuscitation due to poor planning and ineffective or delayed implementation. This program will review the legal obligations and the consequences of being unprepared for an office emergency. Even though resuscitating a patient is not a routine event, the administrators of sedation and general anesthesia must maintain the tools and data to use in the event of an emergency. Legal standards mandate having a team that can resuscitate a patient just as if it were a from an ICU unit at a hospital or EMT’s. This course will show you how create that team, through organization and effective staff training. You will learn how to organize your crash cart and the rest of your emergency preparedness program, and train the members of your staff to be knowledgeable, effective team members in the management of emergencies. We will review how to store and organize your emergency medications, intubation supplies, intravenous drip supplies, etc in your crash cart for instant retrieval. Plans for virtually “fool proof” labeling and organization for all items–from drugs to batteries–will be discussed. Tips will be provided on how to effectively use your office computer to help provide first-rate teaching materials for your entire office staff. Actual clinical and legal case examples will be utilized to demonstrate fatal outcomes associated with insufficient office organization and emergency drills. In addition, videos of emergency drills will illustrate how to maximize the teaching potential of your drills. The pro24
gram will benefit, and is appropriate for, surgeons, management and staff. References Office Anesthesia Evaluation Manual, The American Association of Oral and Maxillofacial Surgeons. 7th Edition, 2006 Medical Emergencies In The Dental Office, Stanley F. Malamed’s, 5th Edition, Mosby 2000 Advanced Cardiovascular Life Support, American Heart Association, 2006
Anesthetic Management of the Geriatric and Multiple System Compromised Patient Andrea Schreiber, DMD, New York, NY As the baby boomer generation reaches “the golden years,” oral and maxillofacial surgeons will be faced with the challenges of managing the surgical and anesthetic needs of a “graying” population. As the volume of older patients increases seemingly exponentially, so too will the volume of older patients requiring surgical and anesthetic care. Attendant to older age is the limited ability of the body to recover from physiologic stresses, such as those posed by surgery and anesthesia. The deterioration of an elderly patient’s ability to handle surgical/anesthetic stress combined with the natural incidence of age-related diseases and organ failure and with medical advances that keep patients with chronic diseases alive for longer periods of time, all serve to complicate the safe anesthetic and peri-operative management of this patient population. Assuring pre-operative condition optimization of the elderly patient with multiple organ system diseases will become ever-increasingly more important for the oral and maxillofacial surgeon charged with treating these patients. Familiarity with the Revised Cardiac Risk Index for determining patient cardiac risk for non-cardiac surgery, the impact of diastolic dysfunction, the indications for peri-operative administration of beta blockers, statins, oral anti-hyperglycemic agents, the maintenance or withdrawal of anti-platelet therapy, the management of specific cardiovascular conditions pre-operatively, the timing of non-cardiac surgery following percutaneous coronary intervention, the role of BNP in peri-operative patient management and the neurologic implications of AAOMS • 2008
Symposia aging including cognitive dysfunction are but a few of the issues to be addressed. Peri-operative management challenges including the effects of aging on the pharmacodynamics of anesthetic agents, induction medication dosage adjustments, anesthetic agent choices, the effects of polypharmacy on the incidence of adverse drug reactions, minimization of hypotensive events, aspiration prophylaxis for susceptible populations and post-operative pain management will also be discussed. The field of geriatric anesthesiology is ever-expanding, and it is critical for practitioners to recognize the implications of age and related co-morbidities to the safe perioperative management of these patients. This presentation will focus on pre-operative assessment and preparation of the elderly patient for surgery and anesthesia including risk stratification, indications for pre-operative testing, functional physiologic and cognitive assessment and indications for pre-operative optimization.
AAOMS • 2008
References Sieber FE. Geriatric Anesthesia. McGraw Hill, Medical Publishing Division. 2007 Cook, DJ, Rooke GA. Priorities in Peri-operative Geriatrics. Anesth Analg 2003;96:1823-1836 ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery – Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Anesth Anal 2002;94(5): 1052-1064 Roy RC. What is New in Geriatric Anesthesia? ASA Refresher Anesthesia 2006; 34(1):139-150
Clinical Case Presentation and Response: How Would You Treat This Patient? O. Ross Beirne, DMD, PhD, Seattle, WA No abstract provided.
25
Pulmonary Diseases Norman J. Betts, DDS, MS, Plymouth, MI
Non Cardiac Complications in Office Based Surgery John W. Robinson III, DMD, Asheville, NC
No abstract provided. No abstract provided.
Wednesday, September 17, 2008, 7:30 am–11:30 am
Are You Truly Ready for an Office Anesthetic Emergency? Richard C. Robert, DDS, MS, San Francisco, CA Arthur Curley, JD, Larkspur, CA In every oral and maxillofacial surgery office the care providers must be ready for a medical or anesthetic emergency that could happen on any day, at any time. However, when many new employees begin working in an oral and maxillofacial surgery office, they have limited medical background. Death or serious injury always turns a bright light on the oral surgery office, particularly when it involves delivering conscious sedation or general anesthesia. Claims of substandard care often focus on deficits in resuscitation due to poor planning and ineffective or delayed implementation. This program will review the legal obligations and the consequences of being unprepared for an office emergency. Even though resuscitating a patient is not a routine event, the administrators of sedation and general anesthesia must maintain the tools and data to use in the event of an emergency. Legal standards mandate having a team that can resuscitate a patient just as if it were a from an ICU unit at a hospital or EMT’s. This course will show you how create that team, through organization and effective staff training. You will learn how to organize your crash cart and the rest of your emergency preparedness program, and train the members of your staff to be knowledgeable, effective team members in the management of emergencies. We will review how to store and organize your emergency medications, intubation supplies, intravenous drip supplies, etc in your crash cart for instant retrieval. Plans for virtually “fool proof” labeling and organization for all items–from drugs to batteries–will be discussed. Tips will be provided on how to effectively use your office computer to help provide first-rate teaching materials for your entire office staff. Actual clinical and legal case examples will be utilized to demonstrate fatal outcomes associated with insufficient office organization and emergency drills. In addition, videos of emergency drills will illustrate how to maximize the teaching potential of your drills. The pro24
gram will benefit, and is appropriate for, surgeons, management and staff. References Office Anesthesia Evaluation Manual, The American Association of Oral and Maxillofacial Surgeons. 7th Edition, 2006 Medical Emergencies In The Dental Office, Stanley F. Malamed’s, 5th Edition, Mosby 2000 Advanced Cardiovascular Life Support, American Heart Association, 2006
Anesthetic Management of the Geriatric and Multiple System Compromised Patient Andrea Schreiber, DMD, New York, NY As the baby boomer generation reaches “the golden years,” oral and maxillofacial surgeons will be faced with the challenges of managing the surgical and anesthetic needs of a “graying” population. As the volume of older patients increases seemingly exponentially, so too will the volume of older patients requiring surgical and anesthetic care. Attendant to older age is the limited ability of the body to recover from physiologic stresses, such as those posed by surgery and anesthesia. The deterioration of an elderly patient’s ability to handle surgical/anesthetic stress combined with the natural incidence of age-related diseases and organ failure and with medical advances that keep patients with chronic diseases alive for longer periods of time, all serve to complicate the safe anesthetic and peri-operative management of this patient population. Assuring pre-operative condition optimization of the elderly patient with multiple organ system diseases will become ever-increasingly more important for the oral and maxillofacial surgeon charged with treating these patients. Familiarity with the Revised Cardiac Risk Index for determining patient cardiac risk for non-cardiac surgery, the impact of diastolic dysfunction, the indications for peri-operative administration of beta blockers, statins, oral anti-hyperglycemic agents, the maintenance or withdrawal of anti-platelet therapy, the management of specific cardiovascular conditions pre-operatively, the timing of non-cardiac surgery following percutaneous coronary intervention, the role of BNP in peri-operative patient management and the neurologic implications of AAOMS • 2008
Symposia aging including cognitive dysfunction are but a few of the issues to be addressed. Peri-operative management challenges including the effects of aging on the pharmacodynamics of anesthetic agents, induction medication dosage adjustments, anesthetic agent choices, the effects of polypharmacy on the incidence of adverse drug reactions, minimization of hypotensive events, aspiration prophylaxis for susceptible populations and post-operative pain management will also be discussed. The field of geriatric anesthesiology is ever-expanding, and it is critical for practitioners to recognize the implications of age and related co-morbidities to the safe perioperative management of these patients. This presentation will focus on pre-operative assessment and preparation of the elderly patient for surgery and anesthesia including risk stratification, indications for pre-operative testing, functional physiologic and cognitive assessment and indications for pre-operative optimization.
AAOMS • 2008
References Sieber FE. Geriatric Anesthesia. McGraw Hill, Medical Publishing Division. 2007 Cook, DJ, Rooke GA. Priorities in Peri-operative Geriatrics. Anesth Analg 2003;96:1823-1836 ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery – Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Anesth Anal 2002;94(5): 1052-1064 Roy RC. What is New in Geriatric Anesthesia? ASA Refresher Anesthesia 2006; 34(1):139-150
Clinical Case Presentation and Response: How Would You Treat This Patient? O. Ross Beirne, DMD, PhD, Seattle, WA No abstract provided.
25