PMID- 33382992
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 1531-5053 (Electronic)
IS  - 0278-2391 (Linking)
VI  - 79
IP  - 5
DP  - 2021 May
TI  - Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial 
      Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019).
PG  - 990-999
LID - S0278-2391(20)31425-7 [pii]
LID - 10.1016/j.joms.2020.12.002 [doi]
AB  - PURPOSE: The safety of the team anesthesia model routinely used by the specialty 
      of oral and maxillofacial surgery has recently been called into question. The 
      purpose of this article is to measure the frequency of adverse anesthetic events 
      related to ambulatory surgical procedures performed under intravenous (IV) 
      sedation by the Division of Oral and Maxillofacial Surgery at the Mayo Clinic 
      during a 15-year period using the team anesthesia model. MATERIALS AND METHODS: A 
      retrospective cohort study was designed, and a sample of subjects identified 
      undergoing IV sedation at Mayo Clinic from 2004 to 2019. The primary outcome 
      variable of interest was the presence of anesthetic-related adverse events (AEs) 
      consistent with the World Society of Intravenous Anesthesia International 
      Sedation Task Force's intervention-based definitions of adverse anesthetic 
      events. Additional covariates included patient age, gender, American Society of 
      Anesthesiologists (ASA) score, type of surgical procedure performed, and the 
      type/dosage of medications administered periprocedurally. Univariate logistic 
      regression analysis was used to assess for associations between AEs and 
      covariates. RESULTS: The study identified 17,634 sedations administered to 16,609 
      unique subjects. In 17,634 sedations, 16 (0.1%) AEs and no subject deaths (0%) 
      were identified. There were no statistically significant associations between AEs 
      and age (hazard ratio [HR], 0.4; 95% confidence interval [95% CI], 0.2 to 1.3; 
      P = .13); gender (HR, 0.9; 95% CI, 0.3 to 2.5; P = .87); ASA 2 classification 
      (HR, 1.6; 95% CI, 0.6 to 4.5; P = .33); ASA 3 classification (HR, 1.3; 95% CI, 
      0.1 to 22.0; P = .86), or types of IV sedation medications administered during 
      the procedure: fentanyl (HR, 0.4; 95% CI, 0.02 to 6.3; P = .5); midazolam (HR, 
      1.0; 95% CI, 0.2 to 4.3; P = .98); propofol (HR, 1.0; 95% CI, 0.3 to 3.5; 
      P = .99); or ketamine (HR, 1.0; 95% CI, 0.1 to 7.3; P = .97). CONCLUSIONS: The 
      frequency of AEs (0.1%) and 0% mortality rate reported in this study demonstrate 
      that the anesthesia team model used by oral and maxillofacial surgeons compares 
      favorably to standardized intervention-based adverse anesthetic event outcomes 
      reported by other nonanesthesiology specialties routinely performing outpatient 
      procedural sedation.
CI  - Copyright (c) 2020 American Association of Oral and Maxillofacial Surgeons. 
      Published by Elsevier Inc. All rights reserved.
FAU - Wiemer, Steven J
AU  - Wiemer SJ
AD  - Chief Resident, Division of Oral and Maxillofacial Surgery, Department of 
      Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
FAU - Nathan, John M
AU  - Nathan JM
AD  - Senior Resident, Division of Oral and Maxillofacial Surgery, Department of 
      Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
FAU - Heggestad, Benjamin T
AU  - Heggestad BT
AD  - Chief Resident, Division of Oral and Maxillofacial Surgery, Department of 
      Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
FAU - Fillmore, W Jonathan
AU  - Fillmore WJ
AD  - Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, 
      Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
FAU - Viozzi, Christopher F
AU  - Viozzi CF
AD  - Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, 
      Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
FAU - Van Ess, James M
AU  - Van Ess JM
AD  - Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, 
      Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
FAU - Arce, Kevin
AU  - Arce K
AD  - Assistant Professor of Surgery and Division Chair, Section of Head & Neck 
      Oncologic and Reconstructive Surgery, Division of Oral and Maxillofacial Surgery, 
      Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
FAU - Ettinger, Kyle S
AU  - Ettinger KS
AD  - Assistant Professor of Surgery, Section of Head & Neck Oncologic and 
      Reconstructive Surgery, Division of Oral and Maxillofacial Surgery, Department of 
      Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN. Electronic 
      address: ettinger.kyle@mayo.edu.
LA  - eng
PT  - Journal Article
DEP - 20201205
PL  - United States
TA  - J Oral Maxillofac Surg
JT  - Journal of oral and maxillofacial surgery : official journal of the American 
      Association of Oral and Maxillofacial Surgeons
JID - 8206428
RN  - R60L0SM5BC (Midazolam)
RN  - YI7VU623SF (Propofol)
SB  - IM
MH  - Conscious Sedation/adverse effects
MH  - Humans
MH  - Midazolam/adverse effects
MH  - *Oral and Maxillofacial Surgeons
MH  - Outpatients
MH  - *Propofol
MH  - Retrospective Studies
EDAT- 2021/01/01 06:00
MHDA- 2021/05/15 06:00
CRDT- 2020/12/31 20:09
PHST- 2020/10/20 00:00 [received]
PHST- 2020/12/01 00:00 [revised]
PHST- 2020/12/01 00:00 [accepted]
PHST- 2021/01/01 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/12/31 20:09 [entrez]
AID - S0278-2391(20)31425-7 [pii]
AID - 10.1016/j.joms.2020.12.002 [doi]
PST - ppublish
SO  - J Oral Maxillofac Surg. 2021 May;79(5):990-999. doi: 10.1016/j.joms.2020.12.002. 
      Epub 2020 Dec 5.