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Ambulatory Anesthesia

Chapter by: Karlis, Vasiliki; Bourell, Lauren; Glickman, Robert
in: Management of Complications in Oral and Maxillofacial Surgery by
[S.l.] : wiley, 2022
pp. 1-23
ISBN: 9781119710691
CID: 5460182

Point-of-Care Pregnancy Testing in Outpatient Sedation Anesthesia: Experience from an Urban Hospital-Based Oral and Maxillofacial Surgery Clinic

Konicki, William; Soletic, Luke C; Karlis, Vasiliki; Aaron, Chase
PURPOSE/OBJECTIVE:Pre-surgical point-of-care (POC) pregnancy testing in women of child-bearing age has become routine practice in hospitals across the United States. Its application in the ambulatory care setting is less ubiquitous. The authors herein present its application in their outpatient oral and maxillofacial surgery clinic, as implemented prior to procedures under intravenous sedation. METHODS:This study was implemented as a retrospective, single-center review of clinical records. The authors examined data from Bellevue Hospital Center's oral and maxillofacial surgery clinic for women of child-bearing age undergoing outpatient procedures performed under intravenous sedation during a 22 month time period. The review focused on POC urine human gonadotropin (hCG) results. A basic statistical analysis was performed on the data. Additionally, an examination of the associated costs of this testing was performed. RESULTS:The study included women between 12 and 50 years of age, of which there were 176. Five of the subjects (2.8%) were found to have an elevated hCG suggestive of pregnancy. The average age of those found to be pregnant was 22. All patients were originally scheduled for extraction of third molars. The cost of a single POC hCG test at the authors' institution was $2.00. The cost to identify a single pregnancy within the study period was found to be $70.40. CONCLUSION/CONCLUSIONS:In the authors' experience, POC hCG testing for women of childbearing age is easily integrated into a standardized pre-sedation workflow. Although the medications utilized for outpatient sedation procedures are generally considered safe for both mothers and developing fetuses, implementation of POC hCG testing allows for providers and patients to make more fully informed decisions regarding how to proceed with elective cases in the case of a previously undiagnosed pregnancy. Determination of pregnancy status prior to a procedure may prompt referral for appropriate prenatal care, while limiting surgeons' exposure to medicolegal liability. This study contributes to a small body of extant reports from ambulatory surgery centers and outpatient clinics offering IV sedation, offering providers a context in which to consider their own implementation of routine hCG testing.
PMID: 34153249
ISSN: 1531-5053
CID: 5077382

Oral and Maxillofacial Surgery Journals' Presence on Social Media: An Adaptation to Enhance Publication Readership and Interdisciplinary Collaboration?

Rekawek, Peter; Gallagher, Brendan; Wu, Brendan; Karlis, Vasiliki
PMID: 33895115
ISSN: 1531-5053
CID: 4889202

Outcomes of Clinical Trials on Osteonecrosis of the Jaw

Wu, Brendan W; Lee, Kevin C; Halepas, Steven; Karlis, Vasiliki
OBJECTIVE:The purpose of this study was to provide a cross-sectional view of all registered clinical trials enrolling patients with osteonecrosis of the jaw (ONJ). The primary aim was to report predictors of trial completion and publication of results. MATERIALS AND METHODS/METHODS:This is a cross-sectional study of ONJ trials registered with For each included entry, trial characteristics and endpoints were recorded. Predictors were enrollment size, etiology, study type, intervention type, sponsor, funding, study locations, number of centers, and specialty of the principal investigator. Outcomes were trial status, publication on PubMed, journal of publication, and length of time between endpoints. Associations between predictors and outcomes were evaluated using chi-square tests and t-tests. RESULTS:The final sample included 26 trials. Overall, 50% of trials were completed and 69% of completed trials were published. Three out of four terminated trials were suspended due to lack of funding. The median enrollment for completed trials was 149 participants with a mean length of five years. All trials included medication-related osteonecrosis of the jaw (MRONJ) patients and 26% also included osteoradionecrosis of the jaw (ORNJ) patients. The majority of trials were observational (65%), conducted internationally (62%), and involved multiple centers (54%). Published trials had a mean time of 5.9 years between trial start and publication, which was comparable to trial length (p=0.90) and appeared in either dental (44%) or cancer (56%) journals. Completion and publication rates were not significantly increased by industry sponsorship/funding, larger enrollment sizes, or multi-center involvement. Oral and maxillofacial surgery was the most represented dental specialty of principal investigators (56%). CONCLUSIONS:The majority of completed ONJ trials had their results published in a timely manner. Evidence-based investigation of ONJ is a multi-disciplinary and international effort. Among all specialists, oral and maxillofacial surgeons led the most ONJ trials.
PMID: 34660159
ISSN: 2168-8184
CID: 5043112

Current Status of Instagram Utilization by Oral and Maxillofacial Surgery Residency Programs: A Comparison With Related Dental and Surgical Specialties

Yang, Stephen C; Wu, Brendan W; Karlis, Vasiliki; Saghezchi, Sohail
PURPOSE/OBJECTIVE:The utility of social media in oral and maxillofacial surgery (OMS) residency programs has never been investigated, despite the increasing popularity of such platforms in academic medicine. As a specialty that strives for constant innovation, it is important for OMS programs to participate in the emerging concept of incorporating social media into medical and surgical education. Therefore, this study aimed to evaluate the use of Instagram in OMS residency programs in the United States. METHODS:A cross-sectional study of Instagram search data was performed. The Instagram accounts of OMS residency programs were searched, and their metrics were retrieved from June 1 to June 5, 2020. Factors correlated with the total number of followers were identified. The use of Instagram in OMS residency programs was compared with that in other related dental and surgical residency programs. RESULTS: = 0.98) since December 2018. The median number of followers was 326 (range, 94 to 2,152), and the median number of posts was 9 (range, 2 to 40). The number of Instagram followers was positively correlated with the number of accounts followed, the number of total posts, and the number of educational posts, and it was negatively correlated with the Instagram engagement rate. Instagram presence did not differ among residency programs for orthodontics (18.2%), periodontics (5.5%), and OMS (P = .067). However, Instagram presence in OMS residency programs was significantly lower than that in plastic surgery (74.7%; P < .001) and otolaryngology residency programs (35.0%; P = .011). CONCLUSIONS:Instagram use in OMS residency programs is growing but is significantly lower than that in related surgical fields. This may represent a missed opportunity for promoting collaboration and efficiently delivering useful information to trainees.
PMID: 32950471
ISSN: 1531-5053
CID: 4650282

What Are the Predictors of Craniomaxillofacial Injuries From Hoverboard Accidents?

Wu, Brendan W; Lee, Kevin C; Hsiung, Min-Wei; Karlis, Vasiliki
PURPOSE/OBJECTIVE:A hoverboard, or self-balancing scooter, is a battery-powered vehicle with 2 wheels connected by a longboard that requires handsfree operation. The purpose of the present study was to characterize the emergency department visits for hoverboard-related craniomaxillofacial trauma and determine predictors of injuries and hospital admission. MATERIALS AND METHODS/METHODS:and t tests. RESULTS:The final sample included 440 patients, of whom 51% were male and 74% were pediatric (age, ≤18 years). Pediatric and male patients were both less likely to wear helmets (P < .01). The injuries had most commonly occurred in the winter (38%) and in a home setting (77%). Facial fractures were more likely in adults (P = .03) and in the summer (P = .04). The overall admission rate was 4.3%. The admission rates were greater for those with facial fractures (P = .02) and intracranial injuries (P = .03) but lower for those with soft tissue injuries (P < .01). Street injuries resulted in a greater admission rate compared with home injuries (P = .01). CONCLUSIONS:Craniomaxillofacial injuries from hoverboard accidents have resulted in emergency department visits and hospital admissions since the vehicle's introduction to the consumer market in 2015. Most cases occurred in the winter, which might reflect increased sales and novice riders during the holiday season. Injuries to adults, in the summer or outdoors, appear to be more severe. Intracranial injuries were the most frequent diagnosis; thus, helmet wear is recommended.
PMID: 33131548
ISSN: 1531-5053
CID: 4661192

Are Motorized Scooters Associated With More Severe Craniomaxillofacial Injuries?

Lee, Kevin C; Naik, Keyur; Wu, Brendan W; Karlis, Vasiliki; Chuang, Sung-Kiang; Eisig, Sidney B
PURPOSE/OBJECTIVE:The purpose of the present study was to compare the severity of craniomaxillofacial injuries between accidents involving motorized and nonmotorized standup scooters. MATERIALS AND METHODS/METHODS:We performed a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in the present study if they had involved the head, face, eyeball, mouth, or ear. Study predictors were obtained from both patient and injury characteristics. The study outcome was the probability of hospital admission from the emergency department. A multiple logistic regression model was created to model the probability of admission using all significant univariate predictors. RESULTS:A total of 11,916 records were included in the present study, of which 9.5% had involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries had occurred more often in older individuals (24.0 vs 8.5 years; P < .01). A greater proportion of motorized injuries involved the head (55.0 vs 36.9%; P < .01) and had resulted in concussion (11.5 vs 5.6%; P < .01), fractures (6.7 vs 2.0%; P < .01), and other nonspecified internal organ injuries (31.1 vs 19.6%; P < .01). Motorized scooters had resulted in more than triple the admission rate compared with nonmotorized scooters (13.9 vs 3.7%; P < .01). After controlling for potential confounders, injuries from motorized scooters still had double odds of hospital admission (odds ratio, 2.03; P < .01). CONCLUSIONS:Motorized standup scooters appear to cause more severe injuries than conventional nonmotorized scooters. The recent growth of rentable electric scooters could pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles.
PMID: 32473916
ISSN: 1531-5053
CID: 4476622

Integrating Migraine Surgery Into Oral and Maxillofacial Surgery

Lee, Kevin C; Naik, Keyur; Karlis, Vasiliki; Koch, Alia
PMID: 31887294
ISSN: 1531-5053
CID: 4268822

Pediatric Benign Soft Tissue Oral and Maxillofacial Pathology

Glickman, Alexandra; Karlis, Vasiliki
Despite the many types of oral pathologic lesions found in infants and children, the most commonly encountered are benign soft tissue lesions. The clinical features, diagnostic criteria, and treatment algorithms of pathologies in the age group from birth to 18 years of age are summarized based on their prevalence in each given age distribution. Treatment modalities include both medical and surgical management.
PMID: 26614696
ISSN: 1558-1365
CID: 1864222

Understanding the novel anticoagulant and platelet inhibitory medications and how they compare to their traditional counterparts [Meeting Abstract]

Appelblatt, R; Krutoy, J; Karlis, V
Statement of Problem: According to the Centers for Disease Control (CDC), approximately 26.5 million Americans carry a diagnosis of heart disease, over 2.6 million have atrial fibrillation, and as many as half of a million people are diagnosed with deep vein thromboses (DVT) or pulmonary embolisms (PE) each year.1 As the American population ages and rates of obesity increase, each of those statistics are expected to rise over the foreseeable future. Many of the patients afflictedwith these diagnoses take anticoagulant medications as part of their daily regimen. Oral and maxillofacial surgeons work in one of the most vascular parts of the body, the head and neck. As the statistics indicate, surgeons can expect to frequently encounter patients taking one or more medications that can prolong bleeding or inhibit proper clot formation. As new drugs enter the market, it is important for oral and maxillofacial surgeons to be aware of the pharmacology of these medications and the proper approaches to treating patients taking them. Methods: We undertook a comprehensive review of common outpatient anticoagulant medications, both new and old. Recommendations and guidelines from organizations such as the American Heart Association and the American Society of Hematology were analyzed and compiled with emphasis placed on perioperative management in both elective and emergent situations. Results: The traditional anticoagulants and antiplatelet agents reviewed were low molecular weight heparin, warfarin, fondaparinux, acetylsalicylic acid, and clopidogrel. New medications reviewed include dabigatran, prasugrel, ticagrelor, apixaban and rivaroxaban.2-5 Conclusion: Oral and maxillofacial surgeons can expect to frequently encounter patients taking anticoagulant and anti-platelet medications. It is extremely important to be aware of the risks of surgical treatment while patients are taking these drugs and equally important to be aware of emergency protocols for medication reversal, if possible. We seek to propose !
ISSN: 0278-2391
CID: 549952