Oral & Facial Surgery of Northeast Texas – Texarkana TX
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
|Local Anesthetic||The patient remains totally conscious throughout the procedure. A local anesthetic (eg, 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.
This is best suited for the patient who has no apprehension whatsoever.
|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.
This can be effective for slightly apprehensive patients but has a variable degree of effectiveness for different people. Its effectiveness can be enhanced with oral sedatives.
|Office Based General Anesthesia with Local Anesthetic*||Medications are administered through an intravenous line (IV). 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 complicated medical conditions who require general anesthesia.|
To administer general anesthesia in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training during the oral and maxillofacial surgery residency program. This training is in addition to the four years of out-patient anesthesia experience obtained during the training program. The American Association of Oral and Maxillofacial Surgery (AAOMS)and the Texas Society of Oral and Maxillofacial Surgeons (TSOMS) require an office anesthesia evaluation every five years. All team members must be CPR-certified and have advanced emergency training led by the oral surgeon. In addition, Drs. Bunel, James, and Duke must maintain certification in Advanced Cardiac Life Support and obtain 12 hours of anesthesia continuing education every two years as required by the Texas State Board of Dental Examiners. Further, all of our anesthesia assistant personnel have completed the Dental Anesthesia Assistant National Certifying Examination (DAANCE).
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.
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. Your treatment can be completed under intravenous sedation. 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”.
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 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. If the idea of starting the IV makes you anxious, an oral sedative can be given to you prior to your appointment and/or nitrous oxide can be administered during this part of the procedure. This is very helpful to our younger patients or anyone who is especially nervous.
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. With IV sedation, a constant “drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary. However, the safest anesthetic is one that is administered by a properly trained and experienced doctor and team in a properly equipped facility.
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 to 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 may fall asleep not remembering all of what happened during their appointment.
There are many advantages to using nitrous xxide
- 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 to 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 may not want to use it if you have emphysema, exotic chest problems, MS, a cold or other difficulties with breathing, or you are pregnant. You may want to ask your dentist for a “five-minute trial” to see how you feel with this type of sedation method before proceeding.