The Controversial Role of the Surgeon-Anesthetist: Lessons Learned From Oral and Maxillofacial Surgery

The concept of the surgeon who administers anesthetic agents to achieve an altered state of anxiety or consciousness to perform a desired surgical procedure is well known in oral and maxillofacial surgery. As the safety of non-anesthesiologists delivering sedation or general anesthesia in an outpatient setting continues to be debated, it is important to consider the present influences on the specialty and the evolution of the surgeon-anesthetist as this concept pertains to oral and maxillofacial surgery. Forces within the specialty and external forces within dentistry and the larger medical community have helped to define anesthesia delivery within the oral and maxillofacial surgery office. As anesthesia administration by non-anesthesiologists (including gastroenterologists and radiologists) as well as certified registered nurse anesthetists (CRNAs) continues to be examined, the current status and lessons learned in developing anesthesia practices for oral surgeons are valuable as a potential model for establishing principles for other specialties. Factors that influence and have helped to evolve the practices of oral and maxillofacial surgeons, will be reviewed.