Several methods of anesthesia are available. The specific modality 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.
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 sedative and analgesic (pain- controlling) effect.Usual Indications Simple oral surgery procedures.
Method Office Based General Anesthesia with Local Anesthetic*Description 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), and Diprivan (Propofol). Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Usual Indications 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 may occur in the presence of infection.
Method Hospital or Surgery Center 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 and TMJ surgery. Also indicated for patients with medical conditions such as heart or lung disease who require general anesthesia.
To administer office-based general anesthesia, oral surgeons complete hospital based anesthesia training. As mandated by the State of California, every 5 years, they undergo an in-office evaluation by a state-appointed dental board examiner where a surgical procedure is evaluated under general anesthesia. The office and anesthesia monitoring equipments are evaluated and certified to allow for the safe delivery of IV anesthesia to the public.
Furthermore, their general anesthesia license is renewable every two years with required amounts 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 doctor Fatehi at the time of your consultation.
Intravenous Sedation (“Twilight Sedation”)
Our office offers our patients the option of Intravenous Sedation or Dental Intravenous Anesthesia or to some it is referred to as “Twilight Sedation” for their dental treatment. Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing dental procedures. Intravenous sedation or “IV sedation” (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 – a “twilight sleep”.
IV sedation/anesthesia is administered and monitored by the doctor and eliminates the costly expense of having your treatment carried out in an operating room or same day surgical facility.
How is IV anesthesia administered?
Prior to venipuncture, to maximize comfort, a numbing spray is administered to the skin overlying the intended vein. A thin catheter will be introduced into a vein in your arm or hand, through which medication will be given to help you relax and feel comfortable. Depending on the desired depth of anesthesia, appropriate medications are administered where patients may be placed in a state of general anesthesia or be lightly sedated. At all times the patient is fully monitored.
The goal of IV anesthesia is to use as little medication as possible to get the treatment completed. Reversal agents are readily available, and, although very rarely used, can be administered, should the need for reversal arise.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is an odorless, non irritating, colorless gas which you can breathe. It has been used as an inhalation agent to reduce anxiety in dentistry for many years. Nitrous oxide is safe; the patient receives a mixture of Oxygen and Nitrous Oxide, whose levels can be adjusted based on the desired relaxation effect. The patient will have reduced anxiety and may become relaxed enough to fall asleep.
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 analgesic properties develop.
contraindications to the use of Nitrous Oxide
- If you are, or think, that you may be pregnant.
- If you have emphysema, or Cystic Fibrosis or other difficulties with breathing.
- If you have a sinus infection or a cold, influenza or allergies, preventing you from breathing through your nose.
- If you have had recent ear or eye surgery.