Several methods of anesthesia are available. The method of anesthesia that is chosen 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.
MethodTypes of AnesthesiaDescription of TechniqueUsual Indications
Method Local AnestheticDescription of 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.Usual Indications Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.
Method Nitrous Oxide Sedation with Local AnestheticDescription of Technique 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 relaxing and analgesic (pain- controlling) effect.Usual Indications Simple and short oral surgery procedures for our pediatric patients.
Method Office Based Intravenous Anesthesia with Local AnestheticDescription of Technique 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 Propofol. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Usual Indications Intravenous anesthesia is available for all types of oral surgery. A patient may choose intravenous anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed will choose intravenous anesthesia. Intravenous anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
Method Hospital Based General AnesthesiaDescription of Technique A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.Usual Indications Indicated for patients undergoing extensive procedures such as face and jaw reconstruction or extensive pathology removal and reconstruction. Also indicated for patients with medical conditions such as heart disease or lung disease who require general anesthesia.
To administer intravenous anesthesia in the office, an oral surgeon must have completed hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a state oral surgery association 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 license to perform intravenous anesthesia. The license is renewable every three 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 patient 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.
Intravenous Anesthesia (“Twilight Sedation”)
Our office offers our patients the option of Intravenous Anesthesia or to some it is referred to as “Twilight Sedation” for their surgical treatment. Intravenous Anesthesia helps you to be comfortable and calm when undergoing surgical procedures. Intravenous anesthesia is designed to better enable you to undergo your surgical 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 anesthesia will essentially help alleviate the anxiety associated with your treatment. While you may not always be asleep, you will be comfortable, calm and relaxed, drifting in and out of sleep – a “twilight sleep”.
If you choose the option of intravenous sedation your IV anesthesia is administered and monitored by the doctor therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility.
How is the IV anesthesia 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 anesthesia is to use as little medication as possible to get the treatment completed. With IV anesthesia a constant “drip” of fluids is maintained via the intravenous tube. If necessary, a reversal medication can be administered to reverse the effects of the medications.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous oxide is safe; the patient receives 50-70% nitrous oxide with no less than 30% oxygen. Patients are able to breathe on their own and remain in control of all bodily functions. The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment.
There are many advantages to using Nitrous Oxide
- It’s relaxation effect can be increased or decreased at any time.
- There is no after effect such as a “hangover”.
- No side effects on your heart and lungs, etc.
- Effective in minimizing gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.
Reasons to Not use Nitrous Oxide
Though there are no major contraindications to using nitrous oxide, you cannot use it if you have emphysema, M.S., a cold, plugged ears, or other difficulties with breathing.