This article offers guidance in choosing the most appropriate modality of anaesthesia for oral surgery and the setting in which it is delivered. It attempts to classify the different types of anaesthesia into local anaesthesia, sedation, which it further sub classifies into minimal, moderate and deep, and of course general anaesthesia. The model focused on and defended is the operator / anaesthetist model. Although only discussing the American experience, this article illustrates the contrast between the American and UK protocols for anaesthesia. Office based anaesthesia has become popular in America whilst in the UK following on from the Poswillo report in 1990, general anaesthesia has been mainly administered in a hospital based setting. The American model includes sedating the paediatric age group and administering general anaesthesia, all in an office based setting. Interestingly, in its summary the author states: “The operator / anaesthetist model that is the standard of care for oral surgeons throughout the United States has stood the test of time. Many of our medical colleagues are copying our model as they are forced to manage more patients in an outpatient setting. Our safety record is second to none.” Unfortunately there is no evidence presented for the last remark and I think this is what the debate rests on. One published report would not seem to support this with anecdotal evidence of 31 paediatric deaths in the last 15 years but finding documented evidence is difficult. Perhaps this should be the next area of study? 

Determining the appropriate oral surgery anesthesia modality, setting, and team.
Stronczek MJ.
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David Chin Shong

University of South Manchester NHS Foundation Trust, Manchester, UK

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