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.|
|Office Based light sedation “twilight sedation” with Local Anesthetic||Twilight sedation is designed to better enable you to undergo your dental 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 ..Medications are administered through an intravenous line (I.V.). Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine). Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.||Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions on patinets with anxiety or certain medical conditions.|
|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 / Propofol. 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.|
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Safety is our main goal
To administer general anesthesia in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training in addition to at least 2 years of office based anesthesia. Qualified applicants will then undergo an in office evaluation by a California state dental board appointed examiners. The examiners observe an actual surgical procedure during which general anesthesia is administered to the patient. The examiners also inspect all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiners reports successful completion of the evaluation process, the state dental board will issue the doctor a license to perform general anesthesia. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.
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.
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, 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.