We offer several different levels of anesthesia that range from “wide-awake” local anesthesia only to “completely knocked out” office-based general anesthesia. Our goal is to make you as comfortable as possible, so the method of anesthesia that is chosen for or by you depends upon the nature of the surgical procedure and your individual 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 to more involved procedures such as removal of wisdom teeth and placement of dental implants.
Method“Twilight Sedation” -Moderate intravenous (IV) sedation with Local AnestheticDescription of Technique Medications are administered through an intravenous line (IV). The patient falls asleep and is mostly unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate) and Versed (benzodiazepine). Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.
Office Based General Anesthesia – Deep (IV) Sedation with Local AnestheticMedications 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 Propofol. 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 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 surgery. Also may be indicated for patients with medical conditions such as heart disease or lung disease who would benefit from general anesthesia.
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.
Office-Based General Anesthesia (Deep Intravenous Sedation)
To administer General Anesthesia in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training. In the state of Kentucky, qualified applicants will then undergo an in office inspection by a state dental board appointed examiner. The examiner inspects all monitoring devices and emergency equipment and verifies that the doctor and the surgical staff are prepared to handle 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 general anesthesia. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.
“Twilight Sedation” (Moderate Intravenous Sedation)
Moderate Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing surgical procedures; it will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. Twilight 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.”
How is the IV sedation administered?
A thin plastic 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.
What is the difference between Moderate and Deep IV sedation?
The main difference between moderate and deep sedation is the anesthetic medications that are used.
Moderate IV sedation is limited to one opioid (usually Fentanyl) and one benzodiazepine (usually Versed). Both of these agents are reversible, which makes this method of anesthesia delivery extremely safe. While every individual person is different, and may have various physiological and genetic factors that vary from the norm, most people will respond to moderate sedation by being extremely relaxed and comfortable during the surgical procedure. There may be periods where patients will drift in and out of “awareness,” but will have little to zero recollection of the procedure.
Deep IV sedation is essentially moderate sedation with the addition of an IV general anesthetic such as Propofol or Ketamine. The level of sedation with the addition of these medications is much more profound, which means that for most patients there will be very little to zero occurrences of “awareness” during the surgical procedure. However, because this is a general anesthetic, physiologic reflexes are slowed even more, so doctors must have extensive training and experience. Dr. Schmidt obtained 12 months of training in general anesthesia in his oral & maxillofacial surgery residency at David Grant Medical Center, Travis Air Force base, and has performed thousands of outpatient general anesthesia surgeries since graduating in 2007.
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. If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by the doctor and a certified anesthesia trained assistant, therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical 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 50-70% 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 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 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, 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.