CDA Essentials 2018 • Volume 5 • Issue 6

S upporting Y our P ractice the ASA I and ASA II categories and the well-controlled ASA III patients. Any patients classified beyond that (the classifications range from ASA I – VI) are not within our scope of practice. The second point to remember is to have an appropriate, individualized anesthetic plan for every patient, depending on their comorbidities. Having one approach for all patients is not appropriate. In general, dentists must be cognizant of the challenges involved in the office-based environment, which we know are different from a hospital environment, as we have less resources available to us in the form of personnel. In an emergency, clinicians should seek the help of emergency medical services at an early stage. What about patients with an undiagnosed condition? It is unlikely that a physician or a dentist would miss signs or symptoms of a disease process. This is the importance of the preoperative assessment. It involves investigating everything a patient could possibly have. It’s not just asking, “Do you have hypertension?” It’s also asking them about signs and symptoms related to hypertension, cardiovascular disease, or respiratory disease such as shortness of breath, exercise tolerance, etc. A comprehensive preoperative assessment is a vital part of forming an appropriate anesthetic plan. It is possible that rare, previously undiagnosed conditions may be undetected in the preoperative period when the patient is completely asymptomatic. However, this is very rare. Whatmessage can dentists communicate to patients who are having dental surgery under sedation or general anesthetic? We can tell patients that there is evidence to support the safety of deep sedation and general anesthesia in dental offices in Ontario for the past 40 years. If a patient requires deep sedation or general anesthesia to complete his or her dental care, they should know that the risk of anything catastrophic happening is minimal. What else do you want dentists know about this study? I want to emphasize the importance of critical incident reporting. This study involved retrospective review of data. The ideal way to collect this data would be prospectively which could be facilitated through critical incident reporting. There is a new draft standard of practice from the RCDSO on the use of sedation and general anesthesia in dental practice, which is due to take effect later this year. The draft will institute mandatory reporting of death and adverse events. This is an excellent step in the right direction. The next important step is to have an annual record of how many anesthetics are being administered in the province. This will allow us to accurately calculate new mortality and morbidity rates very quickly. a Reference 1.NkansahPJ,HaasDA,SasoMA.Mortality incidence inoutpatientanesthesia fordentistry inOntario. OralSurgOralMedOralPatholOralRadiolEndod. 1997;83(6):646-51. Watch the full interview with Dr. El-Mowafy on Oasis Discussions wp.me/p2Lv6A-5WI