Anesthesia 

Anesthesia Options

Local Anesthetic (numbing medicine)

The patient remains conscious throughout the procedure. Local anesthetic is administered in the area where the surgery is to be performed. A local anesthetic will control pain, but it will not eliminate noise, pressure, and vibration commonly associated with surgical procedures. Local anesthesia is used in conjunction with the other methods of anesthesia in all oral surgery procedures.

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 limited sedative effect. Nitrous Oxide is usually effective for minimally invasive procedures (like a tooth filling) but is often not adequate for most oral surgical procedures.

Office Based IV General Anesthesia with Local Anesthetic

Medications are administered through an intravenous line (I.V.). The patient is titrated to a specific level of sedation and usually has no memory or awareness of the procedure being performed. The patient maintains spontaneous respiration (you breathe on your own) and is not paralyzed or intubated.  The specific level or depth of sedation depends on individual factors and will be discussed with you at your consultation appointment.

Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Propofol.

Additional medications such as Zofran (anti-nausea), Dexamethasone (steroid to reduce swelling and inflammation), and glycopyrrolate (anti-cholinergic to dry out your mouth and prevent aspiration) are also sometimes used.

Supplemental oxygen is delivered through a nasal breathing apparatus, and the patient’s vital signs, including blood pressure, pulse oximetry, respiratory rate, cardiac electrical activity (EKG), and end-expiratory CO2 are closely monitored.

Hospital or Surgery Center Based General Anesthesia

Surgery is performed in an Operating Room in a hospital or surgery center where an anesthesiologist administers anesthesia.

This is indicated for patients undergoing extensive procedures such as face and jaw reconstruction.  It is also indicated for patients with more extensive medical conditions that require the expertise of an anesthesiologist.  Dr. Stewart or Dr. Michael will discuss the indications and best options for your particular situation.

FAQ’S Regarding IV General Anesthesia

Other than “not being aware of the procedure,” what benefit exists from sedation/anesthesia?

The benefits of office-based anesthesia are numerous for both oral surgeons and patients alike.

As mentioned above, the elimination of patient anxiety with oral surgery procedures is the most significant benefit.  But there are other, less obvious benefits:

KEEPS YOU MOTIONLESS DURING SURGERY

In many instances, surgical procedures require delicate instrumentation and manipulation of bone and tissue, and sudden movement (usually unintentional) can negatively impact the outcome. Adequate sedation/anesthesia will allow a patient to remain very still during surgery.

MAKES THE PROCEDURE SEEM LIKE IT LASTS FOR 2 SECONDS

Some surgical procedures can be lengthy, and it is difficult for anyone to remain calm and still for a prolonged period. This is not an issue when a patient is under sedation/anesthesia.

EVEN WHEN YOU ARE NUMB, YOU STILL FEEL PRESSURE

Local anesthesia (numbing medicine) does not eliminate noises, feelings of pressure, or vibration during a procedure, and this is not an issue with sedation/anesthesia.

How will the anesthesia affect me?

Anesthesia has wide-ranging effects on different people. Most patients emerge from sedation and feel a little groggy for several hours.

On occasion, patients may emerge from sedation feeling disoriented, possibly nauseous, fatigued, or confused.  It is usually impossible to know how you will feel when emerging. Fortunately, the side effects of anesthesia are well known, and precautions are taken to prevent the most common ones.  In general, the undesirable side effects from IV anesthesia are far less than those of inhalational anesthesia (when you are intubated in an OR setting in a Hospital).

JUST BECAUSE IT TOOK YOUR SISTER 6 HOURS TO BE ABLE TO DANCE DOESN’T MEAN IT WILL TAKE YOU THAT LONG

Recovery periods differ for each patient, and how you feel in the first 12-24 hours after your surgery will depend on how your body metabolizes the anesthetic drugs.

Medications, medical conditions, age, sex, etc., can affect the length of recovery from anesthesia.

The best predictor of how you will respond is a previous experience with anesthesia; if this is your first time with office-based anesthesia, then you should understand that your recovery length may be unpredictable.  Although it can vary widely, most people will have some residual grogginess for about 4-6 hours after the procedure.

YOU’RE CONSTANTLY AND THOROUGHLY MONITORED WHILE SEDATED

Many people have conscious anxiety or fear of anesthesia: usually associated with the “loss of control.” Know that while you are sedated, your heart electrical activity (EKG), heart rate, blood oxygen saturation (pulse oximetry), blood pressure, respiratory rate, and end-expiratory carbon dioxide level are being constantly monitored by our team.

For the science nerds like us:  the carbon dioxide levels measured at the end of an exhaled breath (called ETCO2 or End-Tidal CO2) provides critical information that can tell us if your breaths are too deep or shallow (tidal volume) or too rapid or slow (tachypnea or bradypnea).  Adjustments in the medications being administered and oxygen being delivered can be made in accordance with the ETCO2.

We use state-of-the-art monitoring equipment and are very strict about performing frequent monitor checks and calibrations.

Our assistants are DAANCE (Dental Anesthesia Assistant National Certifying Exam) certified. Dr. Stewart and Dr. Michael are BLS, ACLS, and PALS certified.

We posses and maintain all necessary emergency drugs and equipment in our office to be able to smoothly handle any complication that may arise.

What happens if there is a complication with the sedation?

THE KEY IS KEEPING CALM

The great thing about office-based sedation/anesthesia is that complications are rare when appropriate training is in place, and precautions are taken (as is the case in our office).

Nevertheless, some things are beyond our control, and the best policy is to make sure that we are prepared to handle any possible situation that may arise.

We maintain advanced emergency equipment and emergency medications on hand. We, as a team, undergo frequent training drills where we practice our roles in various emergency scenarios.  While we always hope that urgency or emergency scenarios do not arise, we are proud that we place so much emphasis on being well-prepared in case such a situation occurs.

What kind of training is involved in being able to perform office-based general anesthesia?

ORAL AND MAXILLOFACIAL SURGEONS ARE UNIQUE

If you’re receiving office-based sedation/general anesthesia for an oral surgery procedure by an Oral and Maxillofacial Surgeon, know that a highly qualified individual is delivering it.

In the U.S., Oral and Maxillofacial Surgeons must undergo intensive general anesthesia training in a hospital-based residency training program working alongside Anesthesiology residents and being trained by Anesthesiologists.  Oral surgeons can provide IV general anesthesia (this is different than a simple IV sedation or conscious sedation) that can assure your adequate level of anxiolysis and comfort.   A simple IV sedation (which requires significantly less training and expertise) is usually not optimal for patients undergoing most oral surgical procedures!

To be allowed to perform IV general anesthesia, Oral and Maxillofacial Surgeons in Texas must undergo a rigorous anesthesia evaluation of their office (including office layout, equipment, medications, and surgeon knowledge) by a peer from the Texas Society of Oral and Maxillofacial Surgeons.

MAKE SURE YOUR ORAL SURGEON IS BOARD CERTIFIED

Board Certification (American Board of Oral and Maxillofacial Surgery) is essential to consider when evaluating the training of the individual administering your anesthesia.  Oral and Maxillofacial Surgeons undergo a very rigorous written and oral exam to become Board Certified, and anesthesiology is a large part of that exam.  You can be assured that a Board Certified Oral and Maxillofacial Surgeon has proven adequate training and knowledge in anesthesiology.

DON’T BE AFRAID TO ASK QUESTIONS!

THE MORE YOU KNOW….

If you’ve scheduled an oral surgery procedure and feel uneasy about it, don’t be afraid to speak with Dr. Stewart or Dr. Michael or our clinical staff. Asking questions about the procedure, including the anesthesia, is all part of the process and could provide you the comfort and peace of mind you need. Coordinating with a friend or family member to care for you, having trust in your oral surgeon, and understanding the nature of office-based anesthesia are all important.

Want to Learn More About Office Based Anesthesia Near Plano, Denton, Decatur, or Gainesville TX? 

Our priority is your 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 at the time of your consultation. Give us a call today if you have any questions!