Re: Office Anesthesia
From: Joe Cutchin (forcep@intercom.net)
Thu Jan 31 08:42:20 2008
Well, I'll jump in this debate. I did surveys for AAAHC (American
Association Ambulatory Health Care) for 15 years with published
standards of care (which are out there for lawyers) and no one should be
doing conscious sedation ,much less any type inhalation sedation without
the ability to rescue patient. Intubation,crash cart,2nd person
qualified and present,immediate tranportation and a piece of paper that
confirms. It only takes one case to destroy your career. Joe C
Kim Elise Goldman wrote:
> By the way, nitrous will relax a patient but it will not eliminate pain.
> It takes an apprehensive but cooperative patient and turns them into a
> less apprehensive patient. It does not take the place of local
> anesthesia nor narcotics.
>
> HTH
>
> Kim
>
> On Jan 30, 2008, at 11:06 PM, Kim E. Goldman wrote:
>
>> As a board certified oral and maxillofacial surgeon I need to chime in
>> here and say, though it is not complicated you do need proper training
>> to use nitrous, there are some contraindications, and no one should
>> ever deliver nitrous with a system that doesn't have a fail safe valve
>> preventing "blue gassing" someone (giving 100% nitrous). In addition
>> you should have appropriate monitoring equipment (pulse oximetry) and
>> equipment for resuscitation including the ability to deliver 100% 2
>> via face mask. Also you need a closed system with evacuation of the
>> wasted nitrous, med gas line approval by the state in most states and
>> there are OSHA and other regulations regarding what the facility must
>> have to administer nitrous.
>>
>> There are also state licensure laws for the delivery of nitrous
>> (varies from state to state) and for conscious sedation and for
>> general anesthesia as well as a national board for dental anesthesia.
>>
>> Kim
>> On Jan 30, 2008, at 9:14 PM, R. Daniel Braun wrote:
>>
>>> Check with your insurance carrier and do an anesthesia residency.
>>> Look out for aspiration, make sure your oxygen tank doesn't run out
>>> in the middle of the procedure, and know how to do a Nitrous washout
>>> before you start doing this. When I was a resident, we gave nitrous
>>> to our attendings patients for deliveries. We had an aspiration
>>> pneumonia, we had one lady turn blue because the O2 tank ran out and
>>> there was no valve in the room to open another tank. (I took the mask
>>> off and let her breathe room air. Luckily she was able to get by that
>>> way and didn't have problems from all the nitrous still in her system.
>>>
>>> I always wondered how those dentists got away with it.
>>>
>>> Dan
>>>
>>> On Jan 30, 2008 5:54 PM, Andrew Folley <agfolley@hotmail.com
>>> <mailto:agfolley@hotmail.com>> wrote:
>>>
>>> Has anyone ever used Nitrous Oxide for office anesthesia???
>>> Dentists use it or use to use it frequently. I have had no luck
>>> in eliminating the severe intense pain of the office Novasure
>>> which occurs during the 1-2 minutes of ablation. I thought the
>>> Nitrous Oxide might be a good solution???
>>>
>>> --
>>> R. Daniel Braun, MD FACOG(L) CMT
>>> Professor Emeritus
>>> Dept. of Obstetrics and Gynecology
>>> Indiana U. School of Medicine
>>>
>>> R. Daniel Braun
>>>
>>> "Science without Religion is LAME; Religion without Science is
>>> BLIND"
>>> Einstein 1941
>>
>
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