OUTCOMES WITH AMBULATORY ANESTHESIA DELIVERED IN AN ORAL AND MAXILLOFACIAL SURGERY TRAINING PROGRAM
Description
Purpose: To determine the complication rate associated with IV sedation in an oral and maxillofacial surgery residency training program. Materials and methods: This is a prospective cohort study which enrolled patients who would receive IV sedation for oral surgery procedures in the clinic setting of an OMFS residency training program. Trainees chose their own anesthetic technique, and recorded demographic data, anesthetics used and dose, and any intraoperative or postoperative complications. Demographic and medication data were used as predictor variables. Outcome variables included any reported complication. Fisher’s exact test was used to compare complication rate by subgroups. Results: 1,005 patients were treated over an 18-month period. The overall complication rate was 2.29%. The most common complication was post-operative nausea (n=11, 1.09%). Other complications included: emesis (n=1), laryngospasm (n=1), prolonged recovery (n=3), failed sedation due to agitation (n=1), intra-operative hypertension (n=1), post-operative hypertension (n=1), ST elevation (n=1), IV infiltration (n=2), syncope during IV access (n=1), and respiratory depression (n=2). There were no deaths or adverse events requiring escalation of level of care. Ketamine use had a higher rate of post-operative nausea (1.21%). Propofol was associated with lower rate of post-operative nausea (0.68%). Males had a higher rate of complications than females overall (2.4% vs. 2.2%), but females had a higher rate of post-operative nausea and vomiting (0.96% vs. 1.19%). Average length of procedure was greater in the group that experienced complications vs. those who did not (37.5 vs. 31.6 minutes, respectively). None of these differences were statistically significant. Conclusions: Modern IV sedation anesthesia technique utilized in oral and maxillofacial surgery training programs are safe and the complication rate is low. Post-operative nausea is the most common complication. Ketamine may increase the risk of PONV. Prior history is a good predictor of PONV. Length of procedure may increase the risk of complication