Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension. The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
|Method of Anesthesia||Description of Technique||Usual Indications|
|Local Anesthetic||The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures.||Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.|
|Nitrous Oxide Sedation with Local Anesthetic||A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. The patient remains conscious in a relaxed condition. Nitrous oxide has a sedative and analgesic (pain-controlling) effect.||Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.|
|Office-Based General Anesthesia||Medications are administered through an intravenous line (IV). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.||General anesthesia is available for all types of oral surgery. A patient may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose general anesthesia. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.|
|Hospital-Based General Anesthesia||A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.||Indicated for patients undergoing extensive procedures such as jaw reconstruction and fractures. It is also indicated for patients with significant medical conditions such as heart disease or lung disease who require general anesthesia.|
Regulation of Anesthesia Permits
To administer general anesthesia, oral surgeons must have completed at least three months of hospital-based anesthesia training. During this time, they rotate with the anesthesia residents and perform anesthesia for all types of surgery. In private practice in Texas, they undergo an in office evaluation every 5 years. The examiner inspects all monitoring devices and emergency equipment and tests the doctors and the surgical staff on anesthesia-related emergencies. Also, all monitors and emergency equipment are tested and calibrated annually. To maintain office anesthesia privileges, the state board requires 12 hours of continuing education on anesthesia/medical emergencies every 2 years as well as be ACLS (advanced heart resuscitation for adults) and PALS (advanced heart resuscitation for children) certified.
Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.
We offer our patients the option of Intravenous Sedation or “IV sedation” for their surgery. IV sedation can be adjusted to range from “twilight sedation” to general anesthesia (completely asleep). Intravenous sedation helps you to be comfortable and calm when undergoing your procedure. IV sedation is designed to better enable you to undergo your surgery while you are very relaxed; it will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. IV sedation will essentially help alleviate the anxiety associated with your treatment. If we decide that twilight sedation is the best for your case, you may not always be asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep — a “twilight sleep”.
How is the IV Sedation Administered?
A thin catheter will be introduced into a vein in your arm or hand. The catheter will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.
The goal of IV sedation is to use as little medication as possible to get the treatment completed. It is very safe, and actually much safer than oral sedation. With IV sedation a constant “drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is a sweet smelling, non irritating, colorless gas that you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; and is always combined with oxygen. Patients receive no less than 30% oxygen. (The air we all breathe is 21% oxygen.) Patients are able to breathe on their own and remain in control.
There are many advantages to using Nitrous Oxide
- The depth of sedation can be altered at any time to increase or decrease sedation.
- There is no after effect such as a “hangover”.
- Inhalation sedation is safe with no side effects on your heart or brain.
- It works rapidly. In as few as 2–3 minutes its relaxation properties begin to develop.