Harry Miller, M.D

Your Anesthesiologist•Well Trained•Board Certified

Anesthesiology is the field of medicine concerned primarily with rendering patients insensitive to pain and supporting vital organ function during surgery. Anesthesiologists are certified by The American Board of Anesthesiology, which has examined and certified your physician’s competency in the field upon his or her completion of an accredited program of anesthesiology training in the United States.

Your anesthesia provider, Harry Miller, M.D. is a Board Certified Anesthesiologist, a medical doctor who after graduating from medical school has completed a one-year medical or surgical internship, followed by at least a three year residency in the field of Anesthesiology. He’s a cum laude graduate of The University of Pennsylvania and Medical College of Pennsylvania and completed his residency in anesthesiology at the Los Angeles County-USC Medical Center.

Dr. Miller has an extensive practice with experience ranging from hospitals and surgical centers to a wide variety of office settings throughout California and Nevada including many preeminent dental, gynecological, orthopedic and plastic surgery facilities. With almost two decades of exemplary experience working with this extensive range of practitioners his practice has gained the reputation in the community for providing the highest quality of care and service. By benefit of both physician and client word of mouth endorsement he’s been contacted by many physicians and dentists to provide anesthesia to their patients.

Safe•Effective•Comfortable

Because of the Dental Board of Nevada regulations, the increasing clinical need, and the availability of board certified anesthesiologists who sub-specialize in mobile office-based anesthesia children as well as adults are now being treated safely and efficiently in the office setting instead of surgical centers or hospitals. Therefore Dr Miller works with many provider dentists and health plans/medical groups to provide the medically necessary anesthesia required to treat these patients ethically and humanely. In fact outside of his regular hospital practice he administers anesthesia to around 750 patients per year in the dental office setting.

As mentioned previously the standards for providing care in the dental office are mandated by the Dental Board of Nevada. Dr. Miller practices in the dental office setting with strict observance of these State set regulations. His practice provides the same standard of care as would be expected and required in any accredited hospital or surgical center environment.

When entering the dental office he brings with him the same grade of technology found within a traditional operating room. Traveling with a full array of equipment including a portable anesthesia machine, all applicable drugs and emergency supplies, disposable anesthesia equipment and related components he’s able to transform dental offices into mini operating rooms.

All patients are required to fill out an in-depth medical history form at their initial appointment and are given extensive pre and post-operative anesthesia instructions at the same time. All patients or parents are contacted by phone for a proper review of their own or child’s medical history several days in advance of any scheduled procedure.

Any type of pre-existing cardio pulmonary/cerebral disease/etc. requires a pre-op exam by their respective internist/pediatrician or medical/pediatric specialist as in the case of patients with previous cardiac diagnoses. Dr. Miller routinely takes care of patients in the office setting 12 months of age and older and is quite comfortable with patients who otherwise would normally be treated in a hospital setting because of some cardiac or congenital/neuro diagnosis. Dr. Miller also specializes in treating special needs patients of all types.

As far as quality assurance, all patients are contacted later that same day of their procedure and also at 24 hours post-op to make sure there have not been any anesthetic complications. In his practice, nausea and/or uncontrollable pain are a rarity (2-3%) as well as any cardio-pulmonary complications. Twenty plus years of medical anesthesia experience in a variety of settings including trauma, general surgery, pediatrics, oral and maxillofacial surgery, ear/nose/throat etc. adds an additional safety benefit to his patients, their parents, and ultimately to the dental practice.

Any emergency situations would be in accordance with current ACLS/PALS protocols, and all these American Heart Association certifications are kept current with recertification every two years. As far as any situation requiring transfer to a hospital setting 911 would be called and the patient would be transferred by ambulance. This has never happened in a career spanning two decades.

Collectively, what is delivered is the standard of care of a top-tier outpatient anesthesia practice and its associated facility as anything below these standards is unacceptable.

Questions To Ask Your Health Care Professionals

Here are a few questions that you may want to ask your dentist or anesthesiologist prior to you or your child receiving anesthesia.

Q: What kind of monitoring is used during the procedure?

A: As with any type of anesthesia, the vital signs will be electronically monitored throughout the procedure, and for fifteen to forty-five minutes afterwards during the recovery period. The standard monitors are an electrocardiogram (EKG) to continuously monitor the heart rate and rhythm, a blood-pressure cuff, a pulse oximeter to measure the oxygen level of the blood, and a capnogram to measuring the adequacy of ventilation.

Q: What kind of medications are used and how are they administered?

A: General anesthesia, and in this particular instance total intravenous anesthesia (TIVA) is administered through an intravenous catheter. The drugs used are a combination of several sedative/hypnotics, usually propofol and midazolam, and small amounts of pain medications, fentanyl or demerol and toradol (similar to Motrin) being the most common. These medications are used in combination with the injection of a local anesthetic, or “numbing medicine,” at the site of surgery.

All patients receive supplemental oxygen during their procedure either though an oral or nasal airway device. For children about five minutes before your child’s procedure a small pre-med/injection will be given to them which will take effect in a few minutes rendering them asleep and comfortable.

They’ll then be carried back to the procedure room by Dr. Miller where the monitors and IV are placed and the procedure will then begin. Your child will remember falling asleep in your lap and waking up likewise in the recovery area.

Q: What about side effects, I hear people routinely get sick with anesthesia?

A: Most patients will be relieved that TIVA has fewer side effects, especially nausea and vomiting, than occurs with the administration of inhaled gases under general anesthesia. Patients also recover quickly because the medications used are short-acting and rapidly excreted by the body.

Q: Will the level of anesthesia received be sufficient to make one comfortable during the procedure as well as the recovery period immediately afterward?

A: Yes, during general anesthesia you’ll sleep throughout the entire procedure with no memory of it and won’t be aroused, even by painful stimulation. You’ll wake up after the procedure is done.

Q: Can I observe the procedure?

A: We keep the procedure room accessible only to the treating doctors and assistants. You will be reassured in the waiting room that your child or spouse is asleep, doing fine and their procedure is progressing normally.

Q: Who will be monitoring my recovery after the procedure and who decides when I am ready to go home?

A: The anesthesiologist, recovery time is usually complete within 30-60 minutes after the procedure ends. You or your child will be discharged after maintaining adequate oxygenation and may still be sleepy when you leave the office. Some patients may feel a bit groggy for the rest of the day but most bounce back to normal within a few hours.

Q: What about eating afterwards?

A: After discharge clear liquids are recommended for an hour or two and then advancing to soft foods as tolerated. Depending on the amount of dental work done normal dietary habits can resumed the same day.