Fact: Sedation dentistry isn’t just for painful procedures. It’s for anyone who’s had a less than positive past experience in the dentist chair. Here at Midlothian Dental Center, we place patient comfort and safety at the top of our priority list, which is why we are honored to have Certified Registered Nurse Anesthetist, Cathy Harrison on staff. During this Q&A, Cathy shares her extensive background on anesthesia, as well as answers some burning questions about anesthesia in a dental practice setting.
It is a pleasure to introduce myself to the community! Originally from North Carolina, I came to Richmond in 1977 to train at the Medical College of Virginia, Nurse Anesthesiology program. Following graduation in 1979, I began my career as a Certified Registered Nurse Anesthesiologist in the Richmond area. For over 20 years, I worked in a level 2 trauma center in Chesterfield County - CJW, Chippenham. In March 2000, I started my own anesthesia business, LCH Anesthesia Services, LLC, providing anesthesia services for three plastic surgery groups and one periodontist, Dr. Carl Block. It was through Dr. Block that I met and became friends with Dr. Scott Gore. That was the beginning of a wonderful professional relationship, providing moderate sedation in dental offices.
Along with my office-based anesthesia practice, I also worked with the group at St. Mary's Hospital on a part-time basis and had a 26-year career as a Navy Nurse Corps Officer.
CRNAs are doctoral trained professionals in the art and science of anesthesiology. Prior to 2020, the entry-level for nurse anesthesiology practice was a master's degree, bachelor’s degree or certificate in nurse anesthesiology. Following a minimum of two years of critical care nursing, a doctoral candidate is immersed in an intense didactic and clinical anesthesia program for three years. Upon graduation, they have the training and skills to care for patients in an anesthesia care team or independent setting that includes level 1 trauma centers, ambulatory surgery centers, rural hospitals, and offices.
My capstone project for my Doctor of Nurse Anesthesiology Practice was on this very subject. Having a CRNA as a member of the team allows for everyone caring for the patient the ability to do their specific jobs; the dentist concentrates on the dental work, the dental assistant concentrates on her or his job and the CRNA monitors the patient and ensures that the level of sedation is appropriate for the patient and the type of procedure that is being performed. We are trained in advanced airway management and diagnosis and treatment of emergencies in the dental office.
Prior to the patient coming to the office for their dental procedure and moderate sedation, I talk to the patient about what to expect and prepare for before the procedure and afterward. Since I am not in the office to meet them when the care plan is developed, this is a perfect opportunity for me to get to know them and establish a relationship. I love answering their questions and doing some in-depth patient teaching. I believe that this is the first step in allaying to some of their fears and anxiety. On the day of the procedure, I greet them and answer questions that may have come up. I get them comfortable in the dental chair; monitors on, warm blanket and start their IV. All of the medications that I administer are through their IV so that I can control the amount and level of moderate sedation to keep them comfortable. Once the procedure is over, I turn off the IV infusion and they are able to walk out of the office within 10 minutes of finishing.
There are patients who have had less than positive experiences in a dental office as a child or adult. We also have patients who are special needs patients, who need extensive dental care in a quiet and comforting environment. The dentists that I work with often need to perform several procedures at one time and patients who receive moderate sedation can remain comfortable for several hours while their dental work is taken care of.
"Will I be asleep the entire time?” We do not provide general anesthesia in the office, however, I assure them that I will be there with them the entire time and that they will be very comfortable. The most stimulating part of the procedure is the administration of the local anesthetic and I let them know that they will not be aware at that time. After the dentist has gotten them comfortable and has moved along in the procedure, they might hear light music playing or light conversation going on, but they will be very comfortable.
I went to nursing school in order to become a CRNA. I had the opportunity to shadow a physician anesthesiologist when I was a senior in high school and decided then that I wanted to have a career in anesthesia. Obviously, I believe that being a CRNA is the best job in nursing and having an independent practice allows me to care for patients the best way that I know-how.
There is something very satisfying in knowing that you have helped someone get the care that they need without the fear and anxiety that can come along with having a dental procedure. Several months ago, I had a patient at Dr. Gore's office who needed quite a bit of care. I treated her the same way that I treat every patient; with respect and compassion. When we finished, I went out to talk to her mother, who started crying and told me how much she appreciated the way I cared for her daughter. She said that no one had ever treated her with so much care and compassion when she had anesthesia in the past.
Patient safety is a priority when it comes to anesthesia care in an office setting. The dentists and staff members at Midlothian Dental Center make every effort to provide a safe and comfortable environment for their patients. We value the team approach to dental care.
We hope you enjoyed this Q&A session with CRNA, Cathy Harrison. If you have any questions about an upcoming appointment or service, please feel free to give our office a call at (804) 794-4588.