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, Dr. Hairr completed 6 months of anesthesia training as an anesthesia resident. During this time, he performed general anesthesia for a wide range of surgical and diagnostic procedures as well as a wide range of patients. 1 month of this training was spent in the ICU as a critical care medicine resident. After this, Dr. Hairr performed hundreds of sedations for oral surgery procedures in the outpatient clinic at the University of Florida. Chapin Oral and Maxillofacial Surgery is appropriately licensed and inspected as to perform outpatient IV sedation.
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.
Our office offers our patients the option of Intravenous Sedation for their oral surgery procedures. All American Society of Anesthesia Monitors are placed during the procedure as to monitor your vital signs. We monitor blood pressure, pulse, oxygen saturation, EKG (electrocardiogram), and end tidal CO2 . IV anesthesia allows to you sleep during the procedure; however, you still maintain your ability to breathe. Mechanical ventilation (as used in an operating room) is not needed.
If you choose the option of intravenous sedation your IV sedation/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 Sedation Administered?
Most patients will have nitrous oxide (laughing gas) administered before any IV is placed. An intravenous catheter will be placed into a vein and will be attached to a line administering IV fluids. Through this line, we are able to administer anesthetic drugs that will induce sleep. Once anesthesia has begun, we still will numb the surgical sites before starting the surgery. Most patients are healthy enough for IV sedation in the office; however, some health problems do affect the level of anesthesia. Those with certain health problems may be lightly sedated, or they may need to have their procedure performed in a hospital setting. This will be discussed in further detail at your consultation.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily functions. The patient may experience mild amnesia and will feel relaxed.
There are many advantages to using Nitrous Oxide
- The depth of sedation can be altered at any time to increase or decrease sedation.
- There is no after effect such as a “hangover”.
- Inhalation sedation is safe with no side effects on your heart and lungs, etc.
- Inhalation sedation is very 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 some pain killing properties develop.
- After the procedure, the affects of the gas are typically gone in 3-5 minutes
Reasons to not use Nitrous Oxide
Though there are few contraindications to using nitrous oxide, you may not want to use it if you have emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask your doctor for a “5 minute trial” to see how you feel with this type of sedation method before proceeding.