Robert C. Bosack, DDS, is an oral and maxillofacial surgeon and clinical assistant professor at the University of Illinois College of Dentistry. He has served as an examiner for the American Board of Oral and Maxillofacial Surgery, and has served on the board of directors of the National Dental Board of Anesthesiology. He is the executive director of Dental Anesthesia Online. Dr. Bosack speaks at national dental and anesthesia conferences and has written professional articles and the book Medical Emergencies in the Dental Office. He maintains a private practice in Orland Park, Illinois. Stuart Lieblich, DMD, is clinical professor in the Division of Oral and Maxillofacial Surgery at the University of Connecticut School of Dental Medicine. He is a Past President of the American Dental Society of Anesthesiology and a past Director of the American Board of Oral and Maxillofacial Surgery. He serves on the editorial board of 3 major journals, has written more than 20 textbook chapters, and is an invited speaker at national conferences. Dr. Lieblich maintains a private practice in Avon, Connecticut.

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• Contributors ixForeword xiiiPreface xvAcknowledgment xviiSection 1: Introduction1 Anesthetic complications—how bad things happen 3Robert C. BosackSection 2: Patient risk assessment2 History and physical evaluation 9Kyle Kramer, Trevor Treasure, Charles Kates, Carrie Klene and Jeffrey Bennett3 Laboratory evaluation 15Kyle Kramer and Jeffrey Bennett4 NPO guidelines 19Kyle Kramer and Jeffrey BennettSection 3: Anesthetic considerations for special patients5 Anesthetic considerations for patients with cardiovascular disease 25Erik Anderson and Robert Bosack6 Anesthetic considerations for patients with respiratory disease 49Robert C. Bosack and Zak Messieha7 Anesthetic considerations for patients with endocrinopathies 61Daniel Sarasin Kevin McCann and Robert Bosack8 Anesthetic considerations for patients with psychiatric illness 71Daniel L. Orr, Robert C. Bosack and John Meiszner9 Anesthetic considerations for patients with neurologic disease 79Joseph A. Giovannitti10 Anesthetic considerations for patients with hepatic disease 85Jeffrey Miller and Stuart Lieblich11 Anesthetic considerations for patients with renal disease 89Marci H. Levine and Andrea Schreiber12 Anesthetic considerations for pediatric patients 93Michael Rollert and Morton Rosenberg13 Anesthetic considerations for geriatric patients 97Andrea Schreiber and Peter M. Tan14 Anesthetic considerations for patients with bleeding disorders 103O. Ross Beirne15 Anesthetic considerations for patients with cancer 113Andrea M. Fonner and Robert C. Bosack16 Anesthetic considerations for pregnant and early postpartum patients 117Robert C. BosackSection 4: Review of anesthetic agents17 Clinical principles of anesthetic pharmacology 123Richard C. Robert18 Local anesthetic pharmacology 129Roy L. Stevens and Robert C. Bosack19 Enteral sedation agents 133Richard C. Robert20 Parenteral anesthetic agents 135Richard C. Robert21 Inhalational anesthetic agents 143Charles Kates, Douglas Anderson, Richard Shamo and Robert Bosack22 Antimuscarinics and antihistamines 151Richard C. Robert23 Drug interactions 155Kyle Kramer and Richard C. RobertSection 5: Monitoring24 Limitations of patient monitoring during office-based anesthesia 163Robert C. Bosack and Ken LeeSection 6: Preparation for adversity25 Crisis resource management 173Joseph Kras26 Simulation in dental anesthesia 177Joseph Kras27 Airway adjuncts 181H.William Gottschalk28 Intravenous fluids 185Cara Riley, Kyle Kramer and Jeffrey Bennett29 Emergency drugs 189Daniel A. HaasSection 7: Anesthetic adversity30 Failed sedation 201Roy L. Stevens and Kenneth L. Reed31 Complications with the use of local anesthetics 207M. Anthony Pogrel, Roy L. Stevens, Robert C. Bosack and Timothy Orr32 Anesthetic adversity – cardiovascular problems 219Robert C. Bosack and Edward C. Adlesic33 Anesthetic adversity—respiratory problems 231Charles F. Cangemi, Edward C. Adlesic and Robert C. Bosack34 Allergy and anaphylaxis 251H.William Gottschalk and Robert C. Bosack35 Anesthetic adversity–neurologic problems 257Michael Trofa and Robert C. Bosack36 Acute adverse cognitive behavioral and neuromuscular changes 261Edward Adlesic, Douglas Anderson, Robert Bosack, Daniel L. Orr and Steven Ganzberg37 Anesthetic problems involving vasculature 271Stuart LieblichSection 8: Post-anesthetic adversity38 Nausea and vomiting 277Edward Adlesic39 Post-anesthetic recall of intraoperative awareness 283Robert C. Bosack40 Delayed awakening from anesthesia 287Stuart E. Lieblich41 Safe discharge after office-based anesthesia 291Stuart Lieblich and Peter M. TanSection 9: When bad things happen42 Morbidity and mortality 295Lewis Estabrooks43 Death in the chair: a dentist’s nightmare 299Glen Crick44 Legal issues of anesthesia complications: risks or malpractice 307Arthur W. CurleySection 10: When should you say no45 When should you say no? 315Andrew Herlich and Robert C. BosackSection 11: AppendicesAppendix A A pilot’s perspective on crisis resource management 323David YockAppendix B Medical emergency manual for the general practitioner 325Robert C. BosackAppendix C Malignant hyperthermia Q & A 337Edward C. Adlesic and Steven I. GanzbergIndex 339

Robert C. Bosack, DDS, is an oral and maxillofacial surgeon and clinical assistant professor at the University of Illinois College of Dentistry. He has served as an examiner for the American Board of Oral and Maxillofacial Surgery, and has served on the board of directors of the National Dental Board of Anesthesiology. He is the executive director of Dental Anesthesia Online. Dr. Bosack speaks at national dental and anesthesia conferences and has written professional articles and the book Medical Emergencies in the Dental Office. He maintains a private practice in Orland Park, Illinois. Stuart Lieblich, DMD, is clinical professor in the Division of Oral and Maxillofacial Surgery at the University of Connecticut School of Dental Medicine. He is a Past President of the American Dental Society of Anesthesiology and a past Director of the American Board of Oral and Maxillofacial Surgery. He serves on the editorial board of 3 major journals, has written more than 20 textbook chapters, and is an invited speaker at national conferences. Dr. Lieblich maintains a private practice in Avon, Connecticut.

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• Contributors ixForeword xiiiPreface xvAcknowledgment xviiSection 1: Introduction1 Anesthetic complications—how bad things happen 3Robert C. BosackSection 2: Patient risk assessment2 History and physical evaluation 9Kyle Kramer, Trevor Treasure, Charles Kates, Carrie Klene and Jeffrey Bennett3 Laboratory evaluation 15Kyle Kramer and Jeffrey Bennett4 NPO guidelines 19Kyle Kramer and Jeffrey BennettSection 3: Anesthetic considerations for special patients5 Anesthetic considerations for patients with cardiovascular disease 25Erik Anderson and Robert Bosack6 Anesthetic considerations for patients with respiratory disease 49Robert C. Bosack and Zak Messieha7 Anesthetic considerations for patients with endocrinopathies 61Daniel Sarasin Kevin McCann and Robert Bosack8 Anesthetic considerations for patients with psychiatric illness 71Daniel L. Orr, Robert C. Bosack and John Meiszner9 Anesthetic considerations for patients with neurologic disease 79Joseph A. Giovannitti10 Anesthetic considerations for patients with hepatic disease 85Jeffrey Miller and Stuart Lieblich11 Anesthetic considerations for patients with renal disease 89Marci H. Levine and Andrea Schreiber12 Anesthetic considerations for pediatric patients 93Michael Rollert and Morton Rosenberg13 Anesthetic considerations for geriatric patients 97Andrea Schreiber and Peter M. Tan14 Anesthetic considerations for patients with bleeding disorders 103O. Ross Beirne15 Anesthetic considerations for patients with cancer 113Andrea M. Fonner and Robert C. Bosack16 Anesthetic considerations for pregnant and early postpartum patients 117Robert C. BosackSection 4: Review of anesthetic agents17 Clinical principles of anesthetic pharmacology 123Richard C. Robert18 Local anesthetic pharmacology 129Roy L. Stevens and Robert C. Bosack19 Enteral sedation agents 133Richard C. Robert20 Parenteral anesthetic agents 135Richard C. Robert21 Inhalational anesthetic agents 143Charles Kates, Douglas Anderson, Richard Shamo and Robert Bosack22 Antimuscarinics and antihistamines 151Richard C. Robert23 Drug interactions 155Kyle Kramer and Richard C. RobertSection 5: Monitoring24 Limitations of patient monitoring during office-based anesthesia 163Robert C. Bosack and Ken LeeSection 6: Preparation for adversity25 Crisis resource management 173Joseph Kras26 Simulation in dental anesthesia 177Joseph Kras27 Airway adjuncts 181H.William Gottschalk28 Intravenous fluids 185Cara Riley, Kyle Kramer and Jeffrey Bennett29 Emergency drugs 189Daniel A. HaasSection 7: Anesthetic adversity30 Failed sedation 201Roy L. Stevens and Kenneth L. Reed31 Complications with the use of local anesthetics 207M. Anthony Pogrel, Roy L. Stevens, Robert C. Bosack and Timothy Orr32 Anesthetic adversity – cardiovascular problems 219Robert C. Bosack and Edward C. Adlesic33 Anesthetic adversity—respiratory problems 231Charles F. Cangemi, Edward C. Adlesic and Robert C. Bosack34 Allergy and anaphylaxis 251H.William Gottschalk and Robert C. Bosack35 Anesthetic adversity–neurologic problems 257Michael Trofa and Robert C. Bosack36 Acute adverse cognitive behavioral and neuromuscular changes 261Edward Adlesic, Douglas Anderson, Robert Bosack, Daniel L. Orr and Steven Ganzberg37 Anesthetic problems involving vasculature 271Stuart LieblichSection 8: Post-anesthetic adversity38 Nausea and vomiting 277Edward Adlesic39 Post-anesthetic recall of intraoperative awareness 283Robert C. Bosack40 Delayed awakening from anesthesia 287Stuart E. Lieblich41 Safe discharge after office-based anesthesia 291Stuart Lieblich and Peter M. TanSection 9: When bad things happen42 Morbidity and mortality 295Lewis Estabrooks43 Death in the chair: a dentist’s nightmare 299Glen Crick44 Legal issues of anesthesia complications: risks or malpractice 307Arthur W. CurleySection 10: When should you say no45 When should you say no? 315Andrew Herlich and Robert C. BosackSection 11: AppendicesAppendix A A pilot’s perspective on crisis resource management 323David YockAppendix B Medical emergency manual for the general practitioner 325Robert C. BosackAppendix C Malignant hyperthermia Q & A 337Edward C. Adlesic and Steven I. GanzbergIndex 339

Robert C. Bosack, DDS, is an oral and maxillofacial surgeon and clinical assistant professor at the University of Illinois College of Dentistry. He has served as an examiner for the American Board of Oral and Maxillofacial Surgery, and has served on the board of directors of the National Dental Board of Anesthesiology. He is the executive director of Dental Anesthesia Online. Dr. Bosack speaks at national dental and anesthesia conferences and has written professional articles and the book Medical Emergencies in the Dental Office. He maintains a private practice in Orland Park, Illinois. Stuart Lieblich, DMD, is clinical professor in the Division of Oral and Maxillofacial Surgery at the University of Connecticut School of Dental Medicine. He is a Past President of the American Dental Society of Anesthesiology and a past Director of the American Board of Oral and Maxillofacial Surgery. He serves on the editorial board of 3 major journals, has written more than 20 textbook chapters, and is an invited speaker at national conferences. Dr. Lieblich maintains a private practice in Avon, Connecticut.

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• Contributors ixForeword xiiiPreface xvAcknowledgment xviiSection 1: Introduction1 Anesthetic complications—how bad things happen 3Robert C. BosackSection 2: Patient risk assessment2 History and physical evaluation 9Kyle Kramer, Trevor Treasure, Charles Kates, Carrie Klene and Jeffrey Bennett3 Laboratory evaluation 15Kyle Kramer and Jeffrey Bennett4 NPO guidelines 19Kyle Kramer and Jeffrey BennettSection 3: Anesthetic considerations for special patients5 Anesthetic considerations for patients with cardiovascular disease 25Erik Anderson and Robert Bosack6 Anesthetic considerations for patients with respiratory disease 49Robert C. Bosack and Zak Messieha7 Anesthetic considerations for patients with endocrinopathies 61Daniel Sarasin Kevin McCann and Robert Bosack8 Anesthetic considerations for patients with psychiatric illness 71Daniel L. Orr, Robert C. Bosack and John Meiszner9 Anesthetic considerations for patients with neurologic disease 79Joseph A. Giovannitti10 Anesthetic considerations for patients with hepatic disease 85Jeffrey Miller and Stuart Lieblich11 Anesthetic considerations for patients with renal disease 89Marci H. Levine and Andrea Schreiber12 Anesthetic considerations for pediatric patients 93Michael Rollert and Morton Rosenberg13 Anesthetic considerations for geriatric patients 97Andrea Schreiber and Peter M. Tan14 Anesthetic considerations for patients with bleeding disorders 103O. Ross Beirne15 Anesthetic considerations for patients with cancer 113Andrea M. Fonner and Robert C. Bosack16 Anesthetic considerations for pregnant and early postpartum patients 117Robert C. BosackSection 4: Review of anesthetic agents17 Clinical principles of anesthetic pharmacology 123Richard C. Robert18 Local anesthetic pharmacology 129Roy L. Stevens and Robert C. Bosack19 Enteral sedation agents 133Richard C. Robert20 Parenteral anesthetic agents 135Richard C. Robert21 Inhalational anesthetic agents 143Charles Kates, Douglas Anderson, Richard Shamo and Robert Bosack22 Antimuscarinics and antihistamines 151Richard C. Robert23 Drug interactions 155Kyle Kramer and Richard C. RobertSection 5: Monitoring24 Limitations of patient monitoring during office-based anesthesia 163Robert C. Bosack and Ken LeeSection 6: Preparation for adversity25 Crisis resource management 173Joseph Kras26 Simulation in dental anesthesia 177Joseph Kras27 Airway adjuncts 181H.William Gottschalk28 Intravenous fluids 185Cara Riley, Kyle Kramer and Jeffrey Bennett29 Emergency drugs 189Daniel A. HaasSection 7: Anesthetic adversity30 Failed sedation 201Roy L. Stevens and Kenneth L. Reed31 Complications with the use of local anesthetics 207M. Anthony Pogrel, Roy L. Stevens, Robert C. Bosack and Timothy Orr32 Anesthetic adversity – cardiovascular problems 219Robert C. Bosack and Edward C. Adlesic33 Anesthetic adversity—respiratory problems 231Charles F. Cangemi, Edward C. Adlesic and Robert C. Bosack34 Allergy and anaphylaxis 251H.William Gottschalk and Robert C. Bosack35 Anesthetic adversity–neurologic problems 257Michael Trofa and Robert C. Bosack36 Acute adverse cognitive behavioral and neuromuscular changes 261Edward Adlesic, Douglas Anderson, Robert Bosack, Daniel L. Orr and Steven Ganzberg37 Anesthetic problems involving vasculature 271Stuart LieblichSection 8: Post-anesthetic adversity38 Nausea and vomiting 277Edward Adlesic39 Post-anesthetic recall of intraoperative awareness 283Robert C. Bosack40 Delayed awakening from anesthesia 287Stuart E. Lieblich41 Safe discharge after office-based anesthesia 291Stuart Lieblich and Peter M. TanSection 9: When bad things happen42 Morbidity and mortality 295Lewis Estabrooks43 Death in the chair: a dentist’s nightmare 299Glen Crick44 Legal issues of anesthesia complications: risks or malpractice 307Arthur W. CurleySection 10: When should you say no45 When should you say no? 315Andrew Herlich and Robert C. BosackSection 11: AppendicesAppendix A A pilot’s perspective on crisis resource management 323David YockAppendix B Medical emergency manual for the general practitioner 325Robert C. BosackAppendix C Malignant hyperthermia Q & A 337Edward C. Adlesic and Steven I. GanzbergIndex 339