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 with Local Anesthetic*||Medications are administered through an intravenous line (I.V.). 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 or Surgery Center 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 face and jaw reconstruction and TMJ surgery. Also indicated for patients with medical conditions such as heart disease or lung disease who require general anesthesia.|
To administer general anesthesia in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training. When performing General anesthesia we are required to have two assistants and the surgeon in attendance. We utilize state of the art monitors in our facility including pulse oximetry, electrocadriography, blood pressure, and end tidal CO2 (breathing monitor). Our facility undergoes an office anesthesia evaluation in accordance with the American Association Of Oral and Maxillofacial Surgeons by a state dental board appointed examiner. The examiner inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiner reports successful completion of the evaluation process, the state dental board will issue the doctor a Certificate of Office Anesthesia. This testing and evaluation is repeated every five years. We are also required by the state of Illinois to obtain 6 hour of continuing education in anesthesia every two years. Along with being in compliance with these regulations we also conduct mock anesthesia emergency training with the entire staff and surgeons every six months.
When it comes to anesthesia, our first priority is the patient’s safety and comfort. 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.
Intravenous Sedation (“Twilight Sedation”)
Our office offers our patients the option of Intravenous Sedation ( “Twilight Sedation”). Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing procedures. Intravenous sedation or “IV sedation” (twilight sedation) is designed to better enable you to undergo your procedures 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. 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 needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient’s vein may not be maintainable, in these situations the medications will be administered and the needle retrieved – both scenarios will achieve the same desired level of conscious sedation. 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, much safer than oral sedation. At any time an antidote can be administered to reverse the effects of some of the medications if necessary. Along with IV sedation there are also other different “levels” of sedation available to you in our office.
Sevoflurane/Nitrous Oxide (Laughing Gas)
Sevoflurane and Nitrous Oxide gas are used in young children who are unable to tolerate the placement of an I.V. The gas is slowly introduced and the child has a feeling of euphoria prior to drifting off to sleep. Patients are able to breathe on their own and remain in control of all bodily functions. Once asleep an IV line may be placed to allow other medications to be used for sedation if necessary. This method is safe, effective, rapid and will minimize the stress to our young patients.
Again, our priority is the patients safety and comfort.