Outcomes With Moderate and Deep Sedation in an Oral and Maxillofacial Surgery Training Program

The purpose of the present study was to determine the complication rate associated with the administration of intravenous (IV) sedation in an oral and maxillofacial surgery (OMS) residency training program.

We performed a prospective cohort study that enrolled patients who had received IV sedation for various oral surgery procedures in the clinic setting of an oral and maxillofacial surgery residency training program. The composition of the anesthesia team included residents who had completed their anesthesia rotation, ranging from postgraduate year (PGY)-1 to PGY-4. Each trainee chose their own anesthetic technique and completed a form that included demographic data, types and amounts of anesthetic used, and any intraoperative or postoperative complications encountered. All sedations were performed by a single provider with oversight by an attending oral and maxillofacial surgeon. The demographic and medication data were used as predictor variables. The outcome variables included any reported complications. The Fisher exact test was used to compare the complication rate by subgroup.

The study included 1005 patients treated during an 18-month period. The overall complication rate was 2.29%. The most common complication reported was postoperative nausea (n = 10; 0.99%), with 1 patient experiencing emesis. Other complications included laryngospasm (n = 1), prolonged recovery (n = 3), failed sedation because of agitation (n = 1), intraoperative hypertension (n = 1), postoperative hypertension (n = 1), ST elevation (n = 1), IV infiltration (n = 2), syncope during IV access (n = 1), and respiratory depression (n = 2). No deaths or no adverse events requiring escalation of the level of care occurred. Ketamine use resulted in a greater rate of postoperative nausea (1.21%), and propofol was associated with a lower rate of postoperative nausea (0.68%). Male patients experienced a greater rate of complications compared with female patients overall (2.4 vs 2.2%). However, the female patients had a greater rate of postoperative nausea and vomiting (0.96 vs 1.19%). Of those who had reported a previous history of postoperative nausea and/or vomiting (PONV), 50% experienced symptoms after sedation. The average length of the procedure was longer in the group that had experienced complications compared with those who had not (37.5 vs 31.6 minutes). None of these reported differences were statistically significant.

The results of the present study have demonstrated that the modern IV sedation anesthesia technique used in OMS training programs is safe and the complication rate is low. Postoperative nausea was the most common complication. Ketamine can increase the risk of PONV, and propofol can reduce the risk of PONV. However, larger studies are required for conclusive findings. A history of PONV is a good predictor of PONV. The length of the procedure might increase the risk of complications.