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Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients
Allison L. Spera DMD, MS,
 Mark A. Saxen DDS, PhD,
 Juan F. Yepes DDS, MD, MPH, MS, DrPH,
 James E. Jones DMD, MSD, EdD, PhD, and
 Brian J. Sanders DDS, MS
Article Category: Research Article
Volume/Issue: Volume 64: Issue 3
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-64-04-05
Page Range: 144 – 152

The use of office-based anesthesia (OBA) continues to shape the way surgical procedures are provided in the United States. Today an estimated 1 in every 4 elective surgical procedures is performed in the office-based setting, accounting for over 10 million cases annually. 1 The migration of elective surgeries from hospitals to outside venues began approximately 30 years ago, and has grown exponentially since then. In 1984, approximately 400,000 outpatient procedures were performed in nonhospital settings. 2 By the year 2000, the number of

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; Eighty-five percent of pediatric patients seen by American Society of Dentist Anesthesiologists dentist anesthesiologists were ages 6 or younger, 12% were ages 7–12, and 4% were ages 13–18. The mean age of all patients was 4.7 years (SD = 2.9 years).
Allison L. Spera,
 Mark A. Saxen,
 Juan F. Yepes,
 James E. Jones, and
 Brian J. Sanders

Eighty-five percent of pediatric patients seen by American Society of Dentist Anesthesiologists dentist anesthesiologists were ages 6 or younger, 12% were ages 7–12, and 4% were ages 13–18. The mean age of all patients was 4.7 years (SD = 2.9 years).


Mark A. Saxen,
 Richard D. Urman,
 Juan F. Yepes,
 Rodney A. Gabriel, and
 James E. Jones
<bold>Figure 1</bold>
Figure 1

Most patients receiving general anesthesia from either OR anesthesia providers (a) or dentist anesthesiologists (b) are children between 2 and 6 years of age. This age range also corresponds to the ages in which early childhood caries is found.


Mark A. Saxen,
 Richard D. Urman,
 Juan F. Yepes,
 Rodney A. Gabriel, and
 James E. Jones
<bold>Figure 2</bold>
Figure 2

(a) A comparison of surgical case duration in National Anesthesia Clinical Outcomes Registry–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry (SAMBA-SCOR) registries. Surgical duration is defined as the difference between surgical start and stop times, in minutes. (b) A comparison of ambulatory surgery center and office-based venues with regard to induction time, perioperative time, and recovery time. All cases were performed by the dentist anesthesiologists in the SAMBA-SCOR registry.


Mark A. Saxen,
 Richard D. Urman,
 Juan F. Yepes,
 Rodney A. Gabriel, and
 James E. Jones
<bold>Figure 3</bold>
Figure 3

Age distributions for the National Anesthesia Clinical Outcomes Registry–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry data sets (also shown in Figures 1a and 1b) and superimposes them on a graph where the y-axes are equalized. The near superimposition of the plots suggests a common source of patients for both registries. This source is most likely the population of children with early childhood caries.


Mark A. Saxen,
 Richard D. Urman,
 Juan F. Yepes,
 Rodney A. Gabriel, and
 James E. Jones
<bold>Figure 4</bold>
Figure 4

This graph compares the mean age of patients undergoing general anesthesia in this study to the mean age of patients undergoing general anesthesia in oral surgery offices, as reported by Perrott et al. 4 Although no significant difference in age is noted between the patients in the National Anesthesia Clinical Outcomes Registry (NACOR)–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry (SAMBA-SCOR) data sets in this study, the difference in mean age for oral surgery patients is highly significant for both NACOR-DENTAL and SAMBA-SCOR.


Mark A. Saxen,
 Richard D. Urman,
 Juan F. Yepes,
 Rodney A. Gabriel, and
 James E. Jones
<bold>Figure 5</bold>
Figure 5

A comparison of total anesthesia time in the data sets of this study to total anesthesia time for patients undergoing general anesthesia in oral surgery offices, as reported by Perrott et al. 4 Nearly all cases of general anesthesia performed by oral surgeons are less than 30 minutes in length, whereas cases of 1–2 hours' duration or longer comprise a significant proportion of cases seen by the providers in the National Anesthesia Clinical Outcomes Registry–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry data sets.


Mark A. Saxen DDS, PhD,
 Richard D. Urman MD, MBA,
 Juan F. Yepes DDS, MD, MPH, MS, DrPh,
 Rodney A. Gabriel MD, and
 James E. Jones DMD, EdD, PhD
Article Category: Research Article
Volume/Issue: Volume 64: Issue 4
Online Publication Date: Jan 01, 2017
Page Range: 212 – 220
Article Category: Research Article
Volume/Issue: Volume 64: Issue 4
Online Publication Date: Jan 01, 2017
Page Range: 267 – 267

Nonnarcotic analgesics, 127 Nonselective β-adrenergic antagonist, 221 OBA, 144, 212 Office-based anesthesia, 144, 212 Operating room, 212 Operative time, 8 Opioid use disorder, 178 Opioids, 178 Oral surgery, 8, 105, 127, 136 Orthognathic surgery, 3 Outcomes, 144 Pain, 73, 80 Palmoplantar pustulosis, 173 Parker Flex-Tip, 240 Pediatric, 33 Pediatric dental rehabilitation, 144 Percutaneous tracheostomy, 85