Health Team

Ask questions to reduce risks during office medical procedures

Posted December 26, 2014

Trae Bremer, 22, loved playing basketball for Campbell University, but his knees didn't.

“Through the years of playing basketball on it, it's kind of more wear and tear,” said Bremer, a senior.

Dr. William Hage, with Triangle Orthopaedic Surgery Center, will perform an arthroscopy on Bremer’s left knee to remove bits of broken cartilage.

More medical procedures are being done in office settings or non-hospital surgical centers. There are great cost savings involved, but there can also be great risks.

Bremer will undergo his procedure while under general anesthesia.

“About 70 percent of orthopaedic surgeries are done in an ambulatory setting like this,” Hage said, referring to Triangle Orthopaedic.

Hage says it costs about $2,000 less than in a hospital, and infection rates are actually lower.

With sedation dentistry and oral surgery, it's not unusual for work to be done in a much smaller place – such as Dr. Spencer Howard's office in Durham.

Wherever anesthesia is used, patients should ask about who's doing it.

“(That’s) very important,” Howard said. “Patients should always make sure that their doctor has an anesthesia license for general anesthesia.”

Kelly Roberts, 30, had four impacted wisdom teeth that needed to be removed. That surgery could be done with conscious sedation.

“I'm sure with everyone who goes under, you always wonder, is this safe?” she said. “I just felt like it would be better if I were put under and had the procedure done.”

WRAL health expert Dr. Allen Mask said there are risks with sedation. The death of comedian Joan Rivers is an example. She died a week after what should have been a simple endoscopy in a New York clinic. Investigators concluded that her vocal cords swelled after an unauthorized biopsy, and she couldn't breathe.

“I'm a big fan of what I call ‘critical care’ monitors. These monitors are very similar to the ones used in an ICU,” Howard said.

When his patients are under, they are connected to an EKG monitor to track the electrical activity of the heart, a blood pressure cuff and a pulse oximeter, which monitors blood oxygen level.

Board-certified anesthesiologist Dr. Scott McCulloch, who works for Triangle Orthopaedic, says he spends time looking into a patient’s medical and surgical history to make sure he or she is a good candidate for surgery. A thorough review also helps him choose the best type of anesthesia.

“The process begins even weeks prior to their surgery,” he said.

If something goes wrong, the surgeon should be ready to stop the procedure.

“If you don't feel comfortable or confident before you go in, it's going to cause you to have increased anxiety,” Roberts said.

Mask says patients facing a surgery should ask about the lowest level of anesthesia necessary for their procedure. In many oral surgeries, breathing in nitrous oxide is helpful, making patients alert but not as anxious. Also, ask if a regional anesthetic can be done.



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