Stuart E. Lieblich, D.M.D., has an oral and maxillofacial surgery private practice in Avon, Conn. Dr. Lieblich has served as a full-time faculty member at the University of Connecticut, researching projects to improve patient outcomes with preoperative sedation.
His expertise led Dr. Lieblich to sitting on the board of the American Dental Society of Anesthesiology (ADSA), the largest group of its kind, responsible for fellowship examinations in the organization. Dr. Lieblich became the president of the ADSA in 2000.
Following his involvement with ADSA, Dr. Lieblich was an examiner for the American Board of Oral and Maxillofacial Surgery (ABOMS) and again was elected by the national organization to be a director and eventual president. During his time with ABOMS, Dr. Lieblich was primarily involved as the chair of the patient evaluation and outpatient anesthesia section.
Dr. Lieblich has been invited to speak on his expertise in outpatient anesthesia across the United States. DRE was privileged to discuss this topic with Dr. Lieblich.
Q & A with Dr. Lieblich
You have been invited to speak about the benefit of ETCO2 monitoring at many engagements. How important is it to monitor?
As an invited speaker at many state and national meetings, I spend time to review the integration of capnography into our practices, with clinical examples of changes in wave forms based on specific patient changes (e.g. bronchospasm, foreign body obstruction, apnea, etc.). Many in our specialty are just learning of the benefit of capnography.
Although pulse oximetry has been the standard for many years, changes in oxygen saturation are a later finding than the “breath by breath” information that end tidal carbon dioxide provides. Loss of oxygen saturation is delayed and once a patient desaturates, the steepness of the oxygen dissociation curve dictates a very rapid decline in oxygen saturation. The delay in pulse oximetry changes is also affected by the issue that most patients receive supplemental oxygen during the anesthetic.
Has monitoring ETCO2 helped dramatically in your procedures?
Once doctors see the additional benefit of end tidal CO2 monitoring, they are quick to integrate it into their practices. In our practice, we have noted apnea far earlier than pulse oximetry changes, allowing early intervention.
We are at the forefront with starting peer reviewed office evaluations, which now is a national standard, recognized by all 50 states. As part of that process, monitoring our patients plays a vital role. Integrating the routine use of pulse oximetry (a standard for many years), and now capnography will only continue to provide us more information about our patients so that we can provide better care.
Your facility uses the DRE Waveline Touch to monitor ETCO2. What has your experience been with these monitors?
As capnography will be the standard for outpatient anesthesia, OMFS’s throughout the country are starting to integrate this technology in their practice. Our office felt it was important to be at the forefront of this and started investigating the various units available.
Following my personal evaluation, I felt the DRE devices provided the full range of patient parameters. We purchased one DRE Waveline Touch and now have upgraded all of our monitors (4 units) to the Touch. It has a user customizable format and is easily utilized by our clinical staff.
In addition, I was asked by our state OMFS society for my recommendation and, of course, recommended the DRE Waveline Touch or DRE Waveline EZ unit. Since then, others, including the LSU program in Shreveport, have asked for my opinions and have purchased units for their clinics.
What are some opportunities for others in the medical field to hear you speak?
The talks will have a focus on outpatient anesthesia along with many of them including my presentation on capnography. In 2013, I have been invited to speak at:
• Mississippi State Society Meeting in February
• ADSA annual Las Vegas review course in February
• LSU/New Orleans Pearls course in April
• JAWS study group in Naples, Fl. In March
• Dan Osborn lecture in Iowa in April
• Hinds Symposium in Houston, Tex. In April
• NYU Annual Review Course in July
DRE would like to thank Dr. Lieblich for his input and time!