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New sedation course a hit

'Eye-opening' course teaches dentists patient monitoring, airway management

New sedation course a hit
Under pressure: Dr. Anjoo Ely of Novi, Mich., rescues a "patient" with airway obstruction.

There's a big difference between learning about the management of medical emergencies in the dental office and actually performing what's needed to save a life.

That's why Dr. Guy Rosenstiel of Birmingham, Ala., came to Chicago for the ADA's new continuing education course, Recognition and Management of Complications During Minimal and Moderate Sedation.

"I'm extremely interested in emergency preparedness for myself and my staff," said Dr. Rosenstiel, a general practitioner who provides moderate sedation services in his practice. "There is nothing like this training for dentists. You want to prevent this type of thing from happening, but if it does, I will know what to do. This will help me continue to treat patients and support the treatment of medical emergencies."

Dr. Rosenstiel was one of 34 dentists attending the hands-on portion of the new course Oct. 28-29 at ADA Headquarters. The generally accepted training for dentists administering minimal and moderate sedation has been Advanced Cardiac Life Support. As an alternative to ACLS, the ADA course is tailored to the unique needs of dentists with an emphasis on patient monitoring and airway management.

"I'm very proud of the ADA for taking the lead and giving this type of education to every part of our profession because anyone could have a medical emergency," Dr. Rosenstiel said.

Dr. James C. Phero demonstrates equipment.
Faculty: Dr. James C. Phero demonstrates equipment.

"What we've developed is an approach that recognizes the importance of a well-trained dentist and well-trained team that can respond to an emergency," said Dr. Morton Rosenberg, a member of the workgroup that developed the course.

"The dentist cannot do everything him- or herself," said Dr. Rosenberg, professor of oral and maxillofacial surgery and associate professor of anesthesia at the Tufts University Schools of Medicine and Dental Medicine. "What dentists take away from the course are four things: the ability to diagnose a situation, determine how emergent it is, methods to ensure oxygenation and ventilation, and recognition of when to call for help."

Participants described the experience as intense but eye-opening. The scenarios they encountered are ones that dentists administering minimal and moderate sedation could actually face with patients in the office, such as airway obstruction and respiratory depression. Through a series of team and individual assessments, they gained confidence in their ability to successfully monitor a patient and minimize the impact of a medical emergency.

"This course just opened my eyes to all the things that could happen in the office," said Dr. Scott Stanke of Peru, Ill. A periodontist who provides both minimal and moderate sedation, Dr. Stanke pursued the course in order to improve patient safety in his practice.

"A team approach is needed for the overall success of these situations," said Dr. Stanke. "An example that was emphasized in the course is the importance of communication and reiterating instructions and how the team works together to minimize mistakes."

Dr. Joel Weaver, member of the Committee on Anesthesiology, answers questions.

Expert: Dr. Joel Weaver, member of the Committee on Anesthesiology, answers questions.

Dr. Robert Peskin of Garden City, N.Y., attended the course and has been observing its development over the past few years. As a dentist anesthesiologist, he is one of several dentists undergoing faculty training to teach the course.

"This is a wonderful adjunct for practitioners who are utilizing minimal and moderate sedation, and one that has tremendous potential once we are able to offer it in a variety of venues," said Dr. Peskin.

"It's incredibly satisfying to see the course launched with the ADA at last," said Dr. Karen E. Crowley, a workgroup member and an oral and maxillofacial surgeon. "It is a credit to the participants who take part in the course, as it is very challenging, and nothing like sitting with coffee in a lecture. I saw the confidence of the participants increase geometrically throughout the five hours they spent in the course."

Recognition and Management of Complications During Minimal and Moderate Sedation was three years in the making. The 2007 ADA House of Delegates approved revised anesthesia guidelines documents and called for the development of a CE course for minimal and moderate sedation providers that would focus on proper monitoring and airway management and serve as a complement to ACLS training. The ADA Foundation provided a grant, and the Anesthesia Research Foundation of the American Dental Society of Anesthesiology received the grant to develop the course.

That workgroup included some of the most distinguished experts in sedation and anesthesia. In addition to Dr. Rosenberg and Dr. Crowley, the group included Dr. Daniel E. Becker, Dr. James C. Phero and Dr. Ken Reed. The workgroup also has expertise in a range of other relevant topics, such as dental education, emergency management, pharmacology, simulation education and patient safety.

"An incredible amount of work was devoted to developing this curriculum and we are very happy with the results," said Dr. Becker, associate director of medical education for the general practice dental residency at Miami Valley Hospital in Dayton, Ohio. "However, the curriculum can be improved further, and we need to make courses readily accessible to all sedation providers."

To complete the course, participants were required to take the didactic portion on ADA CE Online. Part two brought them to ADA Headquarters in Chicago for pre-assessment, task training, high fidelity activities and a post-assessment. Task training covered oxygenation/ventilation, airway adjuncts, monitoring and drugs.

Efforts are under way to identify a 2011 date to offer the course again at ADA Headquarters. For more information, contact Lois Haglund at haglundl@ada.org or Ext. 2694.

Dr. Scott Stanke, Peru, Ill., Dr. Ralph Burgess, Flint, Mich., and Dr. Franco Cordini, Louisville, Ky., assist.

Communication is key: Dr. Scott Stanke (center), Peru, Ill., leads a team-training exercise Oct. 28. Dr. Ralph Burgess (left), Flint, Mich., and Dr. Franco Cordini, Louisville, Ky., assist.