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 patient’s medical conditions (health concerns) are a factor in deciding the anesthesia option for you as well. Dr. Robinson will discuss that with you and generally there is more than one option. 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.|
|Office Based General Anesthesia with Local Anesthetic*||Medications are administered through an intravenous line (I.V.). The patient falls under a deep sedation and is generally unaware of the procedure being performed. The patient begins to “wake up” after all of the stimulating part of the procedure and is comfortable. Most patients cannot believe that the procedure is over when we prepare them for the recovery area. 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. In some cases, Dr. Robinson will have a Board Certified Anesthesiologist perform anesthesia in his office to provide safe, cost effective option for his patients. A patient’s overall health will be considered for this option as well.||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. May be indicated for children wherein general anesthesia will be needed.|
To administer general anesthesia in the office, an oral surgeon must have completed hospital based anesthesia training under the guidance of anesthesiologists. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiner. The examiner observes an actual surgical procedure during which general anesthesia is administered to the patient. The examiner also inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on 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. 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 the IV Sedation Administered?
A thin, tiny needle will be introduced temporarily into a vein in your arm or hand. This needle will be removed leaving a small tube (catheter) that is attached to an intravenous tube and a bag of fluids 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. 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. Along with IV sedation there are also other different “levels” of sedation available to you in our office. Dr. Robinson’s office is also equipped with a operating like room where, in certain situations, an anesthesiologist can administer the anesthesia eliminating the need to go to a hospital for the surgery.