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, the patient's medical/dental history and the patient’s level of comfort or apprehension.
The following discusses the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
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 Intravenous (IV) Sedation with Local Anesthetic*
Medications are administered through an intravenous line (IV). The patient usually will fall asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Midazolam (benzodiazepine), Ketamine, and Diprivan or Propofol. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored. The appropriate level of anesthesia is determined by the patient, the patient's surgical needs, and medical history. A patient may choose for simple procedures depending on their level of anxiety. IV sedation is available for all types of oral surgery. Most people having their wisdom teeth removed or having a dental implant placed will choose this method. IV sedation may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection. IV sedation to some is referred to as “Twilight Sedation”. 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. For some patients, they may not always be asleep but will be comfortable, calm and relaxed, drifting in and out of sleep – a “twilight sleep”.
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 more severe 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 four months of hospital based anesthesia training on anesthesia service followed by several years of additional training on oral surgery service. Dr. Lussier completed 4 years of anesthesia training at Brooke Army Medical Center and provided services in both the Oral Surgery and Anesthesia Departments at Landstuhl Regional Medical Center. Kerrville OMS underwent two in office evaluations by a state dental board appointed examiner and by the American Association of Oral and Maxillofacial Surgeons (AAOMS) office anesthesia examiner. The examiners inspect all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. The state dental board then issued a special anesthesia 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 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. 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.
NITROUS OXIDE (LAUGHING GAS) is not available at our office.